The death of Farrah Fawcett has thrown a spot light on anal
cancer, a rare disease often linked to a sexually transmitted
virus.
Before her death last week, at age 62, the actress had come to
terms with the illness and agreed to have her suffering and
treatment chronicled for the television documentary "Farrah's
Story," that aired in May.
"She knew that she had the kind of anal cancer that she wasn't
going to ultimately overcome, and decided to leave as much of a
legacy of awareness as she possibly could," her physician, Dr.
Lawrence Piro, said Tuesday before her funeral.
Breast cancer, prostate cancer and colon cancer were all once
unmentionable diagnoses that gradually became commonly discussed,
thanks in part to celebrity disclosures from people like First Lady
Betty Ford, golfer Arnold Palmer and CBS news anchor Katie Couric,
whose husband died of colon cancer.
But the anus is associated not only with defecation but also a
taboo form of sex, observed Dr. Barron Lerner, a Columbia
University physician who wrote "When Illness Goes Public: Celebrity
Patients and How We Look at Medicine."
Lerner, an internist, said he and his patients frequently have
conversations about different cancers and their potential risk
factors. But anal cancer? Anal sex? "I never talk about that with
my patients. It's something that might freak a lot of people out,"
he said.
However, in the wake of Fawcett's illness, it's likely that some
patients will ask about her case and those topics will be
discussed, he said.
To be sure, anal cancer is rare. Only about 5,000 cases are
diagnosed each year in the United States, and there are only about
700 deaths, according to American Cancer Society statistics.
The cancer is often associated with gay men who have anal sex
and immune systems weakened by HIV or other conditions. But
actually, more than half of the diagnoses and deaths occur in
women.
"Having anal cancer diagnosed in Farrah Fawcett makes a point
that it is more common in women than men," said Dr. Mona Saraiya of
the U.S. Centers for Disease Control and Prevention.
"Farrah Fawcett puts a face to the cancer for women," added
Saraiya, an epidemiologist who has studied anal cancer.
It's less clear whether Fawcett's story will have any effect on
promotion of a vaccine that targets HPV, human papilloma virus,
which is blamed for cervical cancer and linked to most anal
cancers.
The vaccine — called Gardasil — came on the market
in 2006 to help prevent cervical cancer. It's designed to protect
against four types of HPV associated with cancers of the cervix,
anus and upper throat.
Piro, Fawcett's doctor, said Gardasil is an important but
underused defense against cancer, and strongly endorsed increased
vaccinations. But he and others stopped short of saying it should
be touted as a measure that will save women from Fawcett's
fate.
HPV has been linked to roughly 70 percent of all anal cancers,
and is believed to cause 90 percent of the squamous-cell form of
anal cancer. Fawcett had the squamous-cell type of cancer. But in
an interview with The Associated Press, Piro said "her tumor was
not necessarily associated with" HPV. He declined further detail,
citing her medical privacy.
She never discussed with him any feelings about whether young
women should get the HPV vaccine, he said.
Studies indicate Gardasil prevents cervical cancer in women who
have not been previously infected by HPV, and that it blocks
HPV-caused genital warts. Scientists say it's likely the vaccine
will prevent many anal cancers, too. But the first study of that
question — in men — is not yet completed. Those results
are expected later this year.
The vaccine's manufacturer, Merck & Co., has declined to
cite Fawcett's case as a reason for women who get the vaccine, a
decision Lerner applauded.
"I think that to the degree that Merck and advocates for the
disease are being cautious, that's great," he said.
But all of this is educational, he added, saying Fawcett's case
may have erased one of the last remaining medical stigmas. If now
we're talking about anal cancer, what's still taboo? "Not much,"
Lerner said.
On the Net:
American Cancer Society on anal cancer:
http://www.cancer.org/docroot/CRI/CRI_2_3x asp ?dt47
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