3025 - Comparison of Colon vs. Anal Cancer Stigma among Persons with HIV

Purpose/Objective(s): Persons with human immunodeficiency virus (PWH) remain at increased risk of developing anal cancer. Anal cancer screening is at its infancy compared to colon cancer screening. As evidence is emerging that screening PWH for anal cancer can decrease risk by treating premalignant lesions, acceptance and adoption of screening by PWH is critical. Understanding the stigma associated with anal cancer is essential to successful screening and early treatment of this malignancy.

Materials/Methods: In 2023, 110 PWH without a history of cancer at a single infectious disease clinic were prospectively randomized 1:1 to complete the validated Cancer Stigma Scale (CASS) survey for either colon or anal cancer. The mean total stigma scores between groups were compared. The six domains of the CASS score include: severity (perception of the seriousness of a cancer diagnosis), personal responsibility (beliefs of a patient with cancer being at fault for the diagnosis), awkwardness (discomfort interacting with someone who has cancer), avoidance (tendency to avoid someone with cancer), policy opposition (opposition to public policies that support patients with cancer), and financial discrimination (should a cancer diagnosis be a barrier to employment or health insurance). Univariate linear regression analyses were also performed.

Results: We enrolled 55 participants to each arm. The average age was 52 (range: 25 – 71) with the majority of individuals identifying as male (n = 77), Black or African American (n = 94), not in a relationship (n = 78), completed high school (n = 85), and an annual household income < $25,000 (n = 71). The mean total CASS score for the colon and anal cancer groups were 63.7 and 53.8 (max possible score 150), respectively, indicating moderate stigma levels. Both arms indicated the perceived severity (13.7 vs. 14.4, max possible score of 30) of a cancer diagnosis – including expected consequences and likelihood of meaningful recovery – was the primary driver of higher stigma scores. PWH who were older, had a family history of cancer, or engaged in anal receptive intercourse were all less likely to feel awkward about cancer (p < 0.05). Lower education levels were more likely to have higher severity, awkwardness, policy opposition, and discrimination scores (all p < 0.05).

Conclusion: Both colon and anal cancer have associated moderate stigma perceived among PWH. Colon cancer had more stigma than anal cancer. Addressing stigma-related barriers in cancer care is essential, particularly as perceived severity of the diagnosis may deter some PWH from seeking timely screening and treatment. Understanding the nuanced differences in the individual factors that are most stigmatizing is important for effective patient-physician communication. Educational campaigns can increase cancer awareness and emphasis on continued effort to mitigate cancer screening stigma. Future research should focus on stigma reduction strategies for a more successful introduction of anal cancer screening among PWH.