OB/GYNs, Male Patients, & Anal Cancer

I am a touch wide-eyed at this news report in NYT detailing the hard line that the American Board of Obstetrics and Gynecology has taken with respect to treating men with anal cancer. The skinny: anal cancer is largely mediated by the same virus that causes most cases of cervical cancer (the human papilloma virus, or HPV). Gynecologists have extensive training in evaluating such cancers, and some GYNs have added men at risk for anal cancer to their patient panels by performing routine screening "anoscopies". The overall number of men cared for by such physicians appears to be very low, but these docs were just mandated by the OB/GYN Board, in no uncertain terms, to drop these patients or risk losing their board certifications. That is, putting it mildly, a pretty heavy sanction.

The logic of the Board is straightforward: OB/GYN is a specialty designed to treat women, period. Two Board members are quoted as emphasizing this, as well as noting that the anoscopy procedure is something that other specialists are capable of learning & performing as a matter of routine. (Side note: I have a colleague in my Infectious Disease division who does a lot of these procedures for our patients--a logical choice given our patient population with many HIV-infected gay men. She has no surgical training, so they have a point.) The article also notes that the Board has concerns about the unscrupulousness of certain OB/GYN doctors who have gone into lucrative business ventures treating men, such as prescribing testosterone treatments, burnishing their credentials with their Board certifications. The Board--understandably, from my perspective--wishes to put a stop to that. That said, I don't think the docs involved in male anoscopies are getting rich by enticing men to have a camera placed in their collective tuchus, so that issue doesn't apply here.

Regardless, the heavy handed no-anoscopies-in-men line is harder for me to comprehend, and though it is true that non-GYNs can perform them, the real issue is whether that's best for patients. "People with various types of medical training can learn the procedure," the article notes, "but experts say that gynecologists are the quickest to master it because of their experience in screening women." There's the rub. One of the docs featured in the article, Elizabeth Stier, is the only professional qualified to perform such procedures. And where does she work? Some Podunk hospital? Um, no: she's at Boston Medical Center, one of the two largest hospitals in New England, staffed by hundreds of doctors. So the loss to these male patients, while small in the grand scheme of things, is nonetheless very real.

--Billy