Anal cancer is primarily caused by human papillomavirus infections and its highest incidence is among men who have sex with men. Since there is no standard screening protocol for anal cancer, a phase II screening study was conducted on the feasibility of self-anal cancer screening. It is important to palpate 360 degrees of the anal canal and we assumed it would require two hands for a single person to accomplish this; thus, participants were encouraged to use two hands for self-palpation of the anal canal if necessary.
Data for 113 single participants were analysed. Participants who did SAE after training by a clinician were asked, using computer-assisted self-interview, to answer if they palpated the anal canal using two hands or one hand. We then compared the characteristics of those who reported using two hands with those who did not using chi square tests and multivariable analysis.
Slightly less than one-third (31%) of participants used both hands for the SAE. Even so, 83% of men claimed to palpate 360 degrees of the anal canal. Of those who examined themselves with both hands, 73% reported previously inserting fingers into the anus for pleasure compared to 49% for those who used one hand (p=0.036). Knowledge of and self-efficacy with SAE technique, education and age were not significantly associated with using two hands. In multivariable analysis, compared to white men, African-American men had 63% lower odds of using both hands for the SAE vs. using one hand.
It is unclear if our assumption of the required use of two hands is correct for all persons, e.g., maybe it is possible to palpate the anal canal with index finger and opposable thumb. Knowing the characteristics of participants who followed directions may be important for tailoring patient education in the next phase of the study. Alternative ways to self-palpate the anal canal should be explored.