What is the risk and testing for HPV that could lead to anal cancel from anal sex?

Question

I am a 62 year old widower considering entering into a monogamous relationship with a 70 year old man I have recently met.  He is married but has had sex with 3 other married male partners over the past 10 years where he was the mostly the insertive partner with no condom use.  His last sex with a man was well over a year ago.  He and I have both taken multiple over the counter oral HIV tests and come up negative (we both are considering a full STD screen just as a precautionary measure for other STD's).  I am comfortable that we can screen for most STD's including HIV which we have already tested negative for.  My main concern is with HPV.  I am a bit paranoid but my understanding is that almost 80% of sexually active adults have or have had HPV at some point (I also understand that you can never get rid of it).  There appears to be no test for HPV in males and no vaccine for anyone in our age group.  In our relationship I would be much more of a bottom and as such am concerned that if he has HPV, that I could get anal HPV from his penetration and that could potentially lead to anal cancer.  Being exclusive, we would both prefer to use no condom but even with a condom HPV can still be spread where the condom isn't in contact.

So my questions are:
- I read that anal cancer is on the rise, but how prevalent is it and what is the risk from the scenario I have described (remember we are looking to be monogamous once we commit to this).
- Anal cancer appears to be very treatable if caught early.  How quickly does it progress?  Would an annual digital rectal exam discover early signs?  Is a 5 year colonoscopy too late?
- I understand that an anal PAP smear (very similar to a Cervical PAP smear) is the best method, but even my Planned Parenthood office doesn't do them?  It would seem that is something all STD clinics would be doing as routine testing of men who have sex with men.  Other than my primary care physician, who I would not want to disclose this to, where does someone turn to get a definitive anal PAP smear as an early diagnostic tool?

Thanks for all the guidance and good work you all do one here!!!

auntiejessi · Answer

HPV is considered an inevitability of sexual activity now, and you are smart to be asking about it. 

Using a condom for anal sex can significantly reduce your risk of HPV, by at least 50%. That's not always realistic in a long-term relationship, though. 

A lot of STDs aren't doing anal paps, though I agree that it's a valuable tool. Unless there is some reason that you don't want to disclose this to your PCP (like your sister's husband's cousin is the receptionist), then you should consider doing that. If it's impossible for you to do because of good reasons (that we don't need to know), then perhaps it's time to find another doctor. Find one who can address all your needs, and one you will be comfortable sharing all aspects of your health with. 

I couldn't find much to support that numbers are increasing - and many times, increasing numbers of something only means that diagnostic tools are getting better, but in the US, only about 8,000 people are diagnosed with anal cancer each year. https://www.mdanderson.org/cancer-types/anal-cancer.html There are about 44,000 HPV-related cancers each year - https://www.cdc.gov/cancer/hpv/statistics/index.htm 

I'm not an oncologist (or any doctor, for that matter), so I can't answer about progression of anal cancer. I can say it's rare, though, and something you probably don't need to overly worry about.

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