A systematic review and meta‐analysis of cytology and HPV‐related biomarkers for anal cancer screening among different risk groups

Abstract

To inform optimal approaches for detecting anal precancers, we performed a systematic review and meta-analysis of the diagnostic accuracy of anal cancer screening tests in different populations with elevated risk for anal cancer. We conducted a literature search of studies evaluating tests for anal precancer and cancer (anal intraepithelial neoplasia grade 2 or worse, AIN2+) published between January 1, 1997 to September 30, 2021 in PubMed and Embase. Titles and abstracts were screened for inclusion and included articles underwent full-text review, data abstraction and quality assessment. We estimated the prevalence of AIN2+ and calculated summary estimates and 95% confidence intervals (CI) of test positivity, sensitivity and specificity and predictive values of various testing strategies, overall and among population subgroups. A total of 39 articles were included. The prevalence of AIN2+ was 20% (95% CI, 17-29%), and ranged from 22% in men who have sex with men (MSM) living with HIV to 13% in women and 12% in MSM without HIV. The sensitivity and specificity of cytology and HPV testing were 81% and 62% and 92% and 42%, respectively, and 93% and 33%, respectively for cytology and HPV co-testing. AIN2+ risks were similar among those testing positive for cytology, HPV, or co-testing. Limited data on other biomarkers (HPV E6/E7 mRNA and p16/Ki-67 dual stain), suggested higher specificity, but lower sensitivity compared with anal cytology and HPV. Our findings provide important evidence for the development of clinical guidelines using anal cytology and HPV testing for anal cancer screening.

Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic

“…We found a high prevalence of dysplasia on cytology and biopsy that is similar to prior studies. About half our cohort had abnormal cytology, with two-thirds having anal HPV infections, which is similar to other published studies [ 17 , 19 , 20 , 18 ]. Sixty-two percent of people biopsied had AIN2+.…”

State Variation in Squamous Cell Carcinoma of the Anus Incidence and Mortality, and Association With HIV/AIDS and Smoking in the United States

“…31 The current screening emphasis is on high-risk PLWHIV given their elevated risk and scarcity of screening resources; however, the contribution of HIV to the SCCA burden among older women is low (, 2%), 4,32 which implies that wide implementation of screening for PLWHIV will be unlikely to have any impact on SCCA prevention/early detection among the general population of aging women, indicating the need to identify other risk groups (eg, history of cervical precancer or highrisk cervical HPV and solid organ transplantation) that may contribute to SCCA burden greatly and thus could be potentially targeted for screening evaluation and implementation. 6,[33][34][35] Future evaluation and implementation of the approaches for early detection of anal cancer (eg, digital anorectal examination or DARE) may also be an important public health opportunity. 36 women incidence rate 2014-2018, and (F) women rate ratios.…”

Global burden of HPV‐attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis

“…43 Emerging data indicate that screening and treatment of anal precancer may reduce SCCA incidence among PLWHIV 44,45 with current priorities to determine the benefit to harm ratios and costeffectiveness of different screening algorithms. 46,47 Indeed, the country-and region-specific concentration of SCCA among PLWHIV that we observe offers an opportunity to build screening infrastructure and capacity, alongside the necessary workforce trained to perform SCCA screening, diagnostic procedures and treatment.…”