Factors associated with anal cancer screening follow-up by high-resolution anoscopy

Apaydin, Kaan Z.; Nguyen, Andrew; Borba, Christina P.C.; Shtasel, Derri; Ulery, Sharon; Mayer, Kenneth H.

doi:10.1136/sextrans-2017-053515

Cited by 11 publications

(9 citation statements)

References 19 publications

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“…In addition, the incidence of HPV-related anal and head and neck cancers is rising steadily in Europe and North America ( 3 , 4 ). Guidelines for screening of HPV-associated cancers are based on cervical cytology and HPV DNA testing ( 5 ) and on anal cytology and high-resolution anoscopy for anal cancer screening in high-risk groups (e.g., HIV patients among men who have sex with men [MSM]) ( 6 , 7 ). In contrast, for head and neck cancers, there is still a lack of validated screening tools for the identification of HPV-driven cancers.…”

Section: Introductionmentioning

confidence: 99%

Detection of Circulating HPV16 DNA as a Biomarker for Cervical Cancer by a Bead-Based HPV Genotyping Assay

et al. 2022

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Section: Introductionmentioning

confidence: 99%

Detection of Circulating HPV16 DNA as a Biomarker for Cervical Cancer by a Bead-Based HPV Genotyping Assay

et al. 2022

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“…A San Francisco-based study of 246 patients with anal HSIL (79% PWH or with other immunocompromise) found that less than 20% underwent treatment from 1996 to 2006 [23]. A slightly higher number (50 of 155 or 32%) of anal HSIL patients (72% of whom were PWH) from a Boston cohort followed up within 6 months of diagnosis [24]. Another New York-based cohort study of MSM with and without HIV found that although 90% of anal HSIL patients received treatment within 65 days of HRA, 35% were lost to follow-up within 1 year [25].…”

Section: Discussionmentioning

confidence: 99%

The other side of screening: predictors of treatment and follow-up for anal precancers in a large health system

Silvera

Martinson²,

Gaisa

et al. 2021

Aids

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Background: Anal cancer disproportionately affects people with HIV (PWH). Highgrade squamous intraepithelial lesions (HSIL) are cancer precursors and treating them might prevent anal cancer. Data on adherence to HSIL treatment and surveillance is limited but needed to identify deficiencies of screening strategies.Methods: We collected data on high-resolution anoscopy (HRA) attendance and outcomes from 2009 to 2019 in a large urban anal cancer-screening program. Patients with an initial HSIL diagnosis were followed for return for HSIL electrocautery ablation within 6 months of index HSIL diagnosis, and follow-up HRA within 18 months of index HSIL diagnosis. We also evaluated predictors of these outcomes in univariable and multivariable analyses.Results: One thousand one hundred and seventy-nine unique patients with an anal HSIL diagnosis were identified and 684 (58%) returned for electrocautery ablation. Of those treated, only 174 (25%) and only 9% of untreated HSIL patients (47 of 495) underwent surveillance HRA within 18 months of index HSIL diagnosis. In multivariable analyses, black patients and PWH regardless of virologic control were less likely to undergo HSIL ablation within 6 months of HSIL diagnosis whereas patients with commercial insurance were more likely to be treated within 6 months of diagnosis. Among treated HSIL patients, PWH with viremia had a lower likelihood of engaging in post-treatment surveillance within 18 months of HSIL diagnosis.Discussion: Even in large specialized anal cancer screening programs adherence to HSIL treatment and surveillance is low. Psychosocial and economic determinants of health may impact retention in care. Addressing both personal and structural barriers to patient engagement may improve the effectiveness of anal cancer screening.

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“…Research on HRA attendance and acceptability largely focuses on retrospective studies of clinic populations [7–10]. Prospective studies of HRA attendance, particularly examining factors such as HIV status and race/ethnicity, are limited.…”

Section: Introductionmentioning

confidence: 99%

The influence of home versus clinic anal human papillomavirus sampling on high-resolution anoscopy uptake in the Prevent Anal Cancer Self-Swab Study

Nitkowski,

Ridolfi,

Lundeen

et al. 2023

Preprint

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BackgroundAnal cancer disproportionately affects men who have sex with men (MSM) living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability.MethodMSM and trans persons 25 years and older were randomized to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA one year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability usingχ2tests.Results62.8% of 196 participants who engaged in screening attended HRA. Although not significant (p=0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.44, 95% CI 1.11 – 1.87) and lower among participants preferring versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53 – 0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) (p=0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), (p=0.04); however, no differences in attendance by race or HIV status were observed in the home arm.ConclusionsHRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.

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Factors associated with anal cancer screening follow-up by high-resolution anoscopy

Cited by 11 publications

References 19 publications

Detection of Circulating HPV16 DNA as a Biomarker for Cervical Cancer by a Bead-Based HPV Genotyping Assay

Detection of Circulating HPV16 DNA as a Biomarker for Cervical Cancer by a Bead-Based HPV Genotyping Assay

The other side of screening: predictors of treatment and follow-up for anal precancers in a large health system

The influence of home versus clinic anal human papillomavirus sampling on high-resolution anoscopy uptake in the Prevent Anal Cancer Self-Swab Study

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