Fawcett's death spotlights a rare cancer

[July 02, 2009]  ATLANTA, Ga. (AP) -- In a perverse twist of medical fate, Farrah Fawcett has become the poster girl for anal cancer, a rare disease often linked to a sexually transmitted virus.

Before her death last week, at age 62, the actress had come to terms with the illness and agreed to have her suffering and treatment chronicled for a television documentary.

"She knew that she had the kind of anal cancer that she wasn't going to ultimately overcome, and decided to leave as much of a legacy of awareness as she possibly could," her physician, Dr. Lawrence Piro, said Tuesday before her funeral.

It is an unexpected legacy for Fawcett, whose feathered hair and electric smile once dominated TV screens. A sexy photo of her in a red swimsuit, taken in the 1970's, was the top-selling pinup of all time. Despite her fame and work as an entertainer, friends say she was protective of her privacy.

But she was stricken by anal cancer, a rarely discussed affliction with symptoms that are sometimes mistaken for hemorrhoids. After tabloids began reporting on her illness, her family acknowledged it and a friend produced "Farrah's Story," a documentary aired in May that showed Fawcett's treatment and suffering.

It was important new information for people unfamiliar with the disease or reluctant to even talk about it, some health officials said.

Breast cancer, prostate cancer and colon cancer were all once unmentionable diagnoses that gradually became commonly discussed, thanks in part to celebrity disclosures from people like first lady Betty Ford, golfer Arnold Palmer and CBS news anchor Katie Couric, whose husband died of colon cancer.

But the anus is associated not only with defecation but also a taboo form of sex, observed Dr. Barron Lerner, a Columbia University physician who wrote "When Illness Goes Public: Celebrity Patients and How We Look at Medicine."

Lerner, an internist, said he and his patients frequently have conversations about different cancers and their potential risk factors. But anal cancer? Anal sex? "I never talk about that with my patients. It's something that might freak a lot of people out," he said.

However, in the wake of Fawcett's illness, it's likely that some patients will ask about her case and those topics will be discussed, he said.

To be sure, anal cancer is rare. Only about 5,000 cases are diagnosed each year in the United States, and there are only about 700 deaths, according to American Cancer Society statistics.

The cancer is often associated with gay men who have anal sex and immune systems weakened by HIV or other conditions. But actually, more than half of the diagnoses and deaths occur in women.

"Having anal cancer diagnosed in Farrah Fawcett makes a point that it is more common in women than men," said Dr. Mona Saraiya of the U.S. Centers for Disease Control and Prevention.

"Farrah Fawcett puts a face to the cancer for women," added Saraiya, an epidemiologist who has studied anal cancer.

It's less clear whether Fawcett's story will have any effect on promotion of a vaccine that targets HPV, human papilloma virus, which is blamed for cervical cancer and linked to most anal cancers.

The vaccine -- called Gardasil -- came on the market in 2006 to help prevent cervical cancer. It's designed to protect against four types of HPV associated with cancers of the cervix, anus and upper throat.

Piro, Fawcett's doctor, said Gardasil is an important but underused defense against cancer, and strongly endorsed increased vaccinations. But he and others stopped short of saying it should be touted as a measure that will save women from Fawcett's fate.

HPV has been linked to roughly 70 percent of all anal cancers, and is believed to cause 90 percent of the squamous-cell form of anal cancer. Fawcett had the squamous-cell type of cancer. But in an interview with The Associated Press, Piro said "her tumor was not necessarily associated with" HPV. He declined further detail, citing her medical privacy.

She never discussed with him any feelings about whether young women should get the HPV vaccine, he said.

Studies indicate Gardasil prevents cervical cancer in women who have not been previously infected by HPV, and that it blocks HPV-caused genital warts. Scientists say it's likely the vaccine will prevent many anal cancers, too. But the first study of that question -- in men -- is not yet completed. Those results are expected later this year.

The vaccine's manufacturer, Merck & Co., has declined to cite Fawcett's case as a reason for women who get the vaccine, a decision Lerner applauded.

"I think that to the degree that Merck and advocates for the disease are being cautious, that's great," he said.

But all of this is educational, he added, saying Fawcett's case may have erased one of the last remaining medical stigmas. If now we're talking about anal cancer, what's still taboo? "Not much," Lerner said.

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On the Net:

American Cancer Society on anal cancer:
http://www.cancer.org/docroot/lrn/lrn_0.asp

[Associated Press; By MIKE STOBBE]

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