Dr. Gary Bucher examines an anal pap smear taken at his Anal Dysplasia Clinic Midwest in Chicago. Bucher started the clinic in 2008 after becoming concerned about the trajectory of anal cancer in high-risk individuals. (Provided photos)

Dr. Gary Bucher wants to take the stigma away from checking for anal cancer. 

He said even when an individual starts showing symptoms of cancer, doctors regularly misdiagnose the problem. 

“They assume it’s hemorrhoids and prescribe hemorrhoid cream,” Bucher said. “Doctors do not want to look. They don’t want to go there. It’s taboo. And the patients don’t want them to go there.” 

A leader in clinical care and research with HIV/AIDS patients for more than 35 years, Bucher saw the rates of anal cancer increasing with people living with human immunodeficiency virus, men having sex with men and other high-risk groups. He started referring patients to colorectal surgeons for anal pap smears. 

Bucher said he soon found his patients were not getting the appropriate evaluation with high-resolution anoscopy. His patients were receiving a rectal exam and a standard anoscopy, according to Bucher. 

Subsequently, they were being told that everything was normal when a high-resolution anoscopy could have determined they had anal precancer. Bucher noted his patients had a false sense of security that they were being evaluated and that all was normal. 

Bucher quickly found that evaluation and treatment of anal and perianal precancer were nonexistent in Chicago and decided he needed to learn how to perform high-resolution anoscopies and treat anal precancer. 

In 2008, he was so concerned about the trajectory of anal disease that he started focusing exclusively on HRAs and HPV-related anal disease treatments, opening the Anal Dysplasia Clinic Midwest in Chicago. 

“You don’t see a lot of anal cancer except in high-risk groups. So, there is not one specialty that would take over that area,” Bucher said. “You go to international meetings and there are breakouts for family practice, GI (gastrointestinal), gynecology. There is not one department that would cover anal cancer.” 

Bucher was principal investigator in the largest anal cancer prevention study ever conducted in the United States. Thirteen percent of the 4,446 U.S. participants in the ANCHOR Study were from Bucher’s clinical practice. 

In 2020, Bucher began to develop a mentorship training program to prepare the next generation of

Dr. Gary Bucher

providers in anal precancer screening and treatment. 

“Anal cancer is pretty rare for the most part in the general population, 2.5 cases per 100,000 people,” Bucher said. “For men in the general population, it is even less, 1 case per 100,000 people.” 

HIV-positive men have a rate of 165 cases per 100,000 individuals. Women who have had cervical cancer have a rate of 30 cases per 100,000. 

“We (as a country) freak out now when any type of cancer hits 7 cases per 100,000 individuals,” Bucher said. 

Bucher suggested that anyone who is HIV-positive should start screening for anal cancer at the age of 35. Most other individuals should start being screened at 45 years of age.  

A rectal exam is sufficient screening for many individuals, he said. 

For individuals at more high-risk of anal cancer, an anal pap smear — a 15- to 20-minute procedure — is recommended. 

“It’s very easy and simple. There is no cleaning you out like in a colonoscopy, Bucher said. “You come in and you go out. We are only examining the first anal canal.” 

The Chicago physician noted that an individual does not have to have anal sex to develop the HPV that can lead to anal cancer. 

“HPVs can be spread from skin-to-skin contact. You can get it through rubbing, touching, feeling,” Bucher said. “You do not need to have anal sex to transmit it.” 

Bucher said getting physicians and patients to talk about and screen for anal cancer is still difficult. 

“There is still a stigma. Most doctors should know to screen patients,” Bucher said. “Patients should now know that they should be screened as a part of ways to prevent cancer.” 

He said having youths get the HPV vaccine at age 11 or 12 before they become sexually active is another key to preventing anal cancer and other types of cancer. 

kbeese@chronicleillinois.com