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However, this improvement in survival led to an increase in the lifetime risk of developing anal cancer, especially among HIV-positive gay and bisexual men.

The model also found that because younger men are more likely to be cured of their precancer without intervention, patients younger than 29 should not be treated and those between 29 and 38 years old should be actively monitored (watch-and-wait approach) in order to prevent treatment-related inconvenience and morbidity that might affect their quality of life.

Given that the HPV vaccine has minimal side effects, we believe that clinicians can consider adopting this practice.

Such practice may have many advantages, such as decreasing the number of treatments a patient needs for precancer recurrence thus decreasing the adverse outcomes of surgical treatment (possibility of scarring, anal stenosis and incontinence).

Many casual relationships establish guidelines or a set of rules.

The two participants in the relationship will reach an agreement about what each expects from the relationship.

Based on the exchange theory, Hughes witnessed an individual dependency on either partner as the exchange of resources, knowledge, rewards, and costs of items, becomes more and more prominent.

Anal cancer is predominantly caused by chronic or persistent human papillomavirus (HPV) infection.

Some in the medical community have identified anal cancer as the next big crisis among HIV-infected gay and bisexual men.

Initiation of anti-retroviral therapy in the 1990s greatly reduced the AIDS-related death rate and improved survival.

In the long run, post-treatment HPV vaccination also has the potential to decrease the lifetime risk of anal cancer, save health care costs for treating patients for recurrence and cancer, and improve their life expectancy and quality of life. Deshmukh, University of Florida; Elizabeth Chiao, Baylor College of Medicine ; Jagpreet Chhatwal, Harvard Medical School , and Scott B.

Cantor, The University of Texas MD Anderson Cancer Center.

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