Nat'l LGBT Cancer Network Goes 'Behind Closed Drawers' on Anal Cancer

When thinking about cancer, many people react with fear, confusion, sadness, and anger. Anal cancer can provoke all of these thoughts, along with additional feelings of embarrassment, uneasiness and a sense of stigma. As a result, the conversation about anal cancer is hidden in a place where the sun doesn't shine.

Now, it's time to shed your anxieties (and your pants) to face anal cancer head on. The National LGBT Cancer Network, in partnership with Tusk and Dagger, is launching a campaign to raise awareness about anal cancer and creating a directory of free/low cost LGBT-friendly anal cancer screening facilities across the country.

Like similar fundraisers including the ALS Ice Bucket Challenge and the Shower Selfie Challenge, the National LGBT Cancer Network now invites you to show your support by donating to bit.ly/BehindClosedDrawers or texting "UNDIES" to 41444, then spreading the word by posting a photo of your underwear on social media and tagging it with #BehindClosedDrawers. They hope to use these photos to add a touch of levity to a subject that is difficult to talk about.

"Some are humorous, some are sexy; people did it in ways that not only showed their underwear which, let's face it, is fascinating, but in ways that reflected them, like where they chose to place their underwear if they were not wearing them," said Liz Margolies, LCSW, Executive Director of the National LGBT Cancer Network.

Margolies teamed up with Joe Kreisberg of NYC-based boutique creative agency Tusk and Dagger and his partner Erik Mace to come up with this social media driven campaign to raise money.

Tackling anal cancer is a natural fit for The National LGBT Cancer Network: while the incidence is relatively rare in the general population (about 1 in 500) it is up to 34 times more prevalent in men who have sex with men, and increasing annually. While there is little confirmed data on transgender people, it is highly likely that those who engage in anal sex with men are also at a much greater risk for the disease.

The majority of anal cancer cases are caused by the human papilloma virus (HPV). HPV can be transmitted through both protected and unprotected anal intercourse and skin-to-skin contact, including manual stimulation. Even those who use condoms are at risk. Anyone can get anal HPV, and most cases aren't dangerous -- of the more than 100 strains, only a few cause cancer.

Young men and women can protect themselves with an HPV vaccine, now recommended for those under 26 years old. Doctors recommend it for both boys and girls, because boys can carry it from girl to girl. Even men who identify as straight are at risk; a study found that about 10 percent had had sex with a man in the previous year. Just saying you identify as straight doesn't mean you are not a risk for HPV and other STIs.

A growing number of physicians and health activists recommend that all men and transgender people who have anal sex with men, especially those who are HIV-positive, be screened every 1-3 years depending on their immunological well-being and CD4 count. They suggest that HIV-negative individuals be screened every 3 years. This work is important, because most people know little about anal cancer, have never been screened for it and don't know that screening tests exist.

"Anal cancer is a huge and growing problem in the LGBT community, especially among MSM and many transgender women," said Margolies. "So few people are aware of it. They're unaware that they need to be screened. And when they're not out to their healthcare provider, who doesn't know they are engaging in anal receptive sex, which could be true of men who have sex with women as well (Farrah Fawcett died of anal cancer), this leads to higher risk of anal HPV, which can lead to anal cancer."

Margolies said that if your doctor doesn't know your risk factors, they would never think to recommend a screening. Signs that you may have anal cancer include bleeding, itching and changes in bowel habits. Be on the lookout for hemorrhoids that don't go away, or any other unusual signs. People who smoke cigarettes are at a higher risk, as are those who are HIV-positive.

"Tobacco use is 65 percent higher in the LGBT community, and men who engage in anal sex, and are HIV-positive and use tobacco have very high risks," said Margolies.

The issue is serious, but Margolies said that looking at anal cancer in a humorous way could help with raising awareness.

"This is to raise awareness about a cancer that has a lot of 'eww' factor to it," said Margolies. "So we deliberately created something that would be fun and sexy, and we hope to use the money raised to create a strong national education campaign about anal cancer risks and let people know where they can get screening for anal cancer. We plan to dig as deep as we have to, to make sure there is someplace within driving distance for everyone across the country. It's easier in big metropolitan areas, but we want everybody to be able to find an LGBT-friendly welcoming provider."

Kreisberg said that donations are coming in, and so are photos on Facebook, Instagram and Twitter, adding, "it doesn't matter where they post, people have followers and do it to their own comfort level."

The plan is to have the campaign branch out, so that when you post with the hashtag and say you've donated, you challenge your friends to do the same. If some of them do it and also challenge others, it will keep branching out, like any other viral challenge.

"We are going to give it a couple of months and see what happens. If it stalls after two or three months, we may wrap it up," said Kreisberg. "If not, we'll reach out to more people. We don't expect to break records in a week, but a couple of months will give us a sense of whether it worked or not."

Margolies said that because the campaign is for both fundraising and awareness, they set the goal low on purpose, with a $10 default donation.

"We don't want money to be the thing that keeps people from participating," she said. "While we want money to develop a large national campaign, we consider this awareness as well. I'm not sure with the ALS Ice Bucket Challenge how many people learned or thought about ALS, but we want those in the LGBT community who engage in anal sex to know, that, like cervical cancer, anal cancer is a very slow-growing cancer where cells go through multiple changes before they're malignant. It is very easy to find cells and burn them off, so you're okay. Even screening can be a form of prevention."

So if you are having unusual symptoms, don't sit on it. Go to the doctor and get it checked out.