Anal dysplasia hides out inside many hard-to-see folds in the anal canal, according to Kauffman. Typically silent or causing mild symptoms such as bleeding, these clusters of cells are often overlooked or confused for hemorrhoids.

Unlike with other routine health checks, many patients skip anal dysplasia screenings due to stigma and fear.

“People are generally uncomfortable with anal health,” said Kauffman.

He reassures patients that anoscopy is not painful. It just causes a sensation of mild pressure, and the exam is complete in 10 to 15 minutes. Numbing cream and a sedative ease the process.

The screening is different than a colonoscopy, which can trip up people, too. Anoscopy and colonoscopy each catch different conditions, with anoscopy zoomed in to see anal cells.

An estimated 79,100 people are living with anal cancer, according to the National Cancer Institute, and new cases and deaths are growing—with around 9,760 diagnoses in 2023. Gay and bisexual men are 20 times more likely to get the cancer, the National LGBT Cancer Network notes, and risk doubles for those who are HIV-positive.

HPV, another main risk factor for anal cancer, eventually affects nearly all sexually active people. For certain communities, though, the virus is more dangerous and can lead to anal dysplasia and, subsequently, cancer.

Men who have sex with men, transgender women and people who have suppressed immune systems should begin annual anoscopies at 35, especially if they smoke. People who have HIV should start younger, at age 25, Kauffman recommends, since HIV and HPV work together to compromise tissue.

Women with past cervical or vulvar precancers, cancers, or perianal warts should also consider annual Pap smears.