Anal Cancer Risk Factors and Prevention
Anal cancer risk tracks three things: HIV status, exposure to HPV, and whether you've already had HPV cause problems somewhere else on your body. Age shapes all three.
It does not track being gay, or being trans. Identity is how we find each other and how we organize. It isn't the biological variable, and when you see a frightening multiplier attached to "gay men," it's almost always a number about men living with HIV that somebody quietly relabeled.
| If this is you | Screening starts at |
|---|---|
| Living with HIV, and a man who has sex with men or a transgender woman | 35 |
| Living with HIV, anyone else | 45 |
| A man who has sex with men, HIV-negative | 45 |
| A transgender woman, HIV-negative | 45 |
| You’ve had vulvar precancer or vulvar cancer | Within a year of that diagnosis |
| You’ve had an organ transplant | 10 years after your transplant |
Worth a conversation with your provider, without a fixed starting age: a history of cervical or vaginal precancer or cancer, a history of perianal warts, or immune suppression from medication or another condition.
1. Living with HIV
A working immune system clears most HPV infections on its own within a couple of years. When it's suppressed, infections persist, and persistence is what eventually changes cells.
Among men who have sex with men living with HIV, anal cancer occurs at roughly 85 cases per 100,000 people per year. In the general population it's somewhere between 1 and 4 per 100,000 depending on age. The increase is large — roughly 20 to 40 times
Age compounds it. In that same group, rates run about 17 per 100,000 under 30 and climb past 100 per 100,000 after 60.
What helps: staying on treatment and in care. Sustained viral suppression and a healthy CD4 count matter here, and they're the reason screening guidelines start earlier for you rather than a reason to feel singled out.
2. Other reasons your immune system might be suppressed
Organ transplant recipients. Anti-rejection medication works by damping down exactly the immune response that clears HPV. Risk climbs the longer you've been on it, which is why the guidelines put screening at ten years post-transplant.
People on immunosuppressive medication for autoimmune conditions like lupus, rheumatoid arthritis, or inflammatory bowel disease.
People being treated for other cancers.
3. A history of HPV causing problems elsewhere
If HPV has already caused precancerous changes somewhere on your body, your anal cancer risk is higher.
A history of vulvar precancer or vulvar cancer is the strongest signal here, and it's the one almost nobody gets told. Anal cancer rates in that group run around 42 to 48 per 100,000 per year — in the same range as the highest-risk groups on this page. The guidelines say screen within a year of that diagnosis.
Cervical or vaginal precancer or cancer also raises risk.
A history of genital or perianal warts points to a past high-risk HPV exposure and is worth mentioning to your provider.
If any of that describes you, you belong in the screening conversation even if nobody has invited you into it.
What this means for our communities
The three factors above are the drivers. Here's how they tend to show up depending on who you are.
Men who have sex with men. Risk is elevated, and HIV status is what separates elevated from substantially elevated. Receptive anal sex is associated with higher rates of anal HPV, which is worth knowing but is not a reason to stop. Screening starts at 35 if you're living with HIV, 45 if you're not.
Transgender women. Named in the screening guidelines at the same ages, 35 with HIV and 45 without. Gender-affirming surgery doesn't change this. Vaginoplasty doesn't remove the anal canal, and screening follows the anatomy you have rather than the marker on your ID.
Lesbian and bisexual women. You've probably been told you're low risk for HPV. That's not necessarily true, and it's one of the more persistent failures in queer healthcare. HPV moves by skin-to-skin contact, including between women, and most bisexual women have had male partners at some point. If you've had cervical or vulvar precancer, that puts you in a higher-risk group than most people realize.
Transgender men and nonbinary people. The guidelines don't address you. That's a gap in the evidence, not a finding that you're safe. The same reasoning applies: if you're living with HIV, have a history of HPV-related precancer, have receptive anal sex, or are immunosuppressed, the logic behind those thresholds is about your situation too. Raise it rather than waiting to be offered.
Being on a list like this isn't a verdict. Most people in every group on this page will never develop anal cancer.
What it means is that you have a starting age, that there's a one-minute exam attached to it, and that you're allowed to ask for it. That's the whole point of knowing.
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IANS Anal Cancer Prevention Screening Toolkit The society that wrote the screening guidelines, with patient-facing explainers. https://iansoc.org/Anal-Cancer-Screening-Tool-Kit
HPV and Anal Cancer Foundation Risk information, patient support, clinical trial navigation. https://www.analcancerfoundation.org
CDC: HPV and Cancer Which cancers HPV causes and how. https://www.cdc.gov/cancer/hpv/
National Cancer Institute: HIV Infection and Cancer Risk Why immune suppression raises risk for HPV-related cancers. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hiv-fact-sheet
LGBTQ+ Healthcare Directory Find an affirming provider. https://lgbtqhealthcaredirectory.org
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Clifford GM, et al. A meta-analysis of anal cancer incidence by risk group: toward a unified anal cancer risk scale. International Journal of Cancer, 2021;148:38–47. Source for every incidence figure on this page. https://bhiva.org/wp-content/uploads/2024/10/A-meta-analysis-of-anal-cancer-incidence-by-risk-group.pdf
Stier EA, et al. International Anal Neoplasia Society's consensus guidelines for anal cancer screening. International Journal of Cancer, 2024. https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.34850
ASCCP Practice Advisory: Anal Cancer Screening. Reproduces the IANS thresholds. https://www.asccp.org/Assets/6e8dcdcb-d093-42ef-97cd-70a8c30dbf3e/638641643094670000/asccp-practice-advisory-anal-cancer-screening-final-pdf
Panel on Opportunistic Infections in Adults and Adolescents with HIV. Human Papillomavirus Disease section. Updated July 2024, reviewed March 2026. https://clinicalinfo.hiv.gov
Palefsky JM, et al. Treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer. New England Journal of Medicine, 2022;386:2273–2282.
Centers for Disease Control and Prevention. HPV Vaccination Recommendations. https://www.cdc.gov/hpv/hcp/vaccination-considerations/index.html