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110849 KAM 4-11

Providence Dysplasia ClinicPreventing anal cancer by diagnosing and treating anal dysplasia

www.providence.org/oregon/cancer

OUR MISSION As people of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.

OUR CORE VALUES Respect, Compassion, Justice, Excellence, Stewardship

Providence Dysplasia ClinicProvidence Cancer Center, 6th Floor, Suite 6N50 Providence Portland Medical Center 4805 NE Glisan St. Portland, OR 97213 Phone: 503-215-1600 Fax: 503-215-1607

Our team:

Michelle Chiu, M.S.N., N.P.-C. Michelle Chiu is a certified adult nurse practitioner trained in the most up-to-date techniques for the diagnosis, treatment and care of patients with anal dysplasia. She is an active volunteer in several local health programs and enjoys participating in community outreach. She is committed to providing high-quality, compassionate and culturally competent care to her patients, their families and partners.

Mark H. Whiteford, M.D., F.A.C.S., F.A.C.R.S. Dr. Whiteford has been a physician and surgeon in the Portland community for 12 years and has been named a “Top Doc in Colon and Rectal Surgery” in Portland Monthly magazine from 2005 to 2010. He is board certified in colon and rectal surgery. As medical director of colon and rectal surgery at Providence Cancer Center, Dr. Whiteford is exceptionally committed to the individualized care of patients throughout their diagnosis and treatment.

ProvidenceCancer Center

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Preventing anal cancer by diagnosing and treating anal dysplasia

What is anal dysplasia? Anal dysplasia is a family of conditions ranging from low-grade lesions, such as warts and early precancers, to high-grade precancerous lesions that have the potential to become anal cancer. Recent reports have shown that an increasing number of people – especially those in high-risk populations – are being diagnosed with high-grade precancerous lesions and anal cancer.

The link between anal dysplasia and HPV Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. Between 50 percent and 75 percent of sexually active men and women get HPV at some point in their lives.

HPV is passed from one person to another through genital contact, most often during vaginal and anal sex, although it can be passed through other forms of sexual contact.

In 90 percent of cases, the body’s immune system clears the HPV infection naturally within two years. In 10 percent of cases, the HPV infection becomes chronic and can cause precancerous anal dysplasia lesions and cancer.

Most people with HPV do not have noticeable symptoms, but that does not mean anal dysplasia has not developed.

Anal cancer Anal cancer is relatively rare in the United States. However, occurrence rates are rising in some high-risk groups. By finding anal dysplasia early and providing treatment, we can prevent the development of some cancers.

Who is most at risk?People at higher risk of developing anal dysplasia include:

• Those with chronically suppressed immune systems, such as those living with HIV or AIDS and those who have received solid organ transplants

• Those who have a history of receptive anal intercourse

• Women with a history of cervical, vaginal or vulvar dysplasia or cancer

• Men who have sex with men• Those who have a history of HPV infection

(including genital or anal warts) or previous anal cancer

• People with chronic anal irritation, growths or lesions that bleed

If you are at increased risk for anal dysplasia, please talk with your primary care provider. The screening for this condition is a simple test, and it can save your life.

Our services At Providence Dysplasia Clinic, our patients receive high quality care in the safest, most efficient way possible. We tailor our services to meet the needs of each patient.

At our clinic, we offer:

• Assessment of the patient’s risk factors and anal health

• Information about HPV and HPV vaccination• Anal Pap smear screenings • High-resolution anoscopy (magnified

examination of the anal canal) to identify precancerous lesions

• Biopsy of lesions that appear abnormal • Treatment of precancerous tissue with topical

and light therapies• Patient education and support for anal health

• Follow-up monitoring for those at risk of developing anal cancer

• Prompt treatment of recurrences • Communication with the patient’s primary

care provider • Collaboration with our multidisciplinary

team, giving the patient access to integrative medicine, nutrition counseling, psychosocial support, and smoking cessation information

Screening and treatment options Simple screenings: All precancerous anal dysplasia lesions and nearly 90 percent of anal cancers are associated with chronic HPV infections. An anal Pap smear is a simple screening test that allows health care providers to detect precancerous changes caused by HPV. If the Pap smear indicates the presence of dysplasia, further examination is done with high-resolution anoscopy and biopsies.

Treatment options: To prevent dysplasia from progressing to cancer, we use high-resolution anoscopy (magnified examination of the anal canal), to accurately diagnose and biopsy abnormal lesions. This outpatient procedure is performed with state-of-the-art diagnostic equipment.

If dysplasia is present, we can use topical therapies and light-based treatments to destroy precancerous lesions.

Office-based procedures, along with high-resolution anoscopy, have been shown to eliminate 80 percent of high-grade precancerous lesions and to reduce to less than one percent the number of lesions that progress into anal cancer.

After treatment, anal dysplasia may occur in new areas and may return to previously treated areas. For that reason, continued monitoring is essential.