International Anal Neoplasia Society Guidelines for the Practice of Digital Anal Rectal Examination

Abstract

The aim of the study was to develop recommended techniques and quality assurance metrics for the practice of Digital Anal Rectal Examination (DARE). Materials and Methods: The International Anal Neoplasia Society undertook a literature review and, using the AGREE II technique, developed guidelines for performing DARE. Results: A consensus was formed regarding the optimum conditions and characteristics of DARE. Several Quality Assurance metrics were developed. Conclusions: Digital Anal Rectal Examination is a cheap and potentially universally available technique, which has the potential to facilitate the early diagnosis of anal cancers, when they are most amenable to treatment. These guidelines provide a basis for teaching the technique and may be used as for evaluation research.

Evaluating the Utility and Prevalence of HPV Biomarkers in Oral Rinses and Serology for HPV-related Oropharyngeal Cancer

“…The fact that HPV16 E6 antibody seropositivity may have utility for screening for anal cancer (44) as well as OPC is an important consideration for appropriate triage/evaluation of biomarker positive individuals. Like HPV-OPC, anal cancer is another HPV-related cancer for which optimal screening approaches remain unclear (45)(46)(47), and research suggests these same HPV DNA biomarkers (DEIA and Cobas) also have high specificity and moderate sensitivity for anal precancer (48,49). The low prevalence of E6 antibodies, even among the high-risk group of HIVinfected individuals and men who have sex with men in this study, supports a possible higher positive predictive value of this marker in highlighting those as risk.…”

Exploring the Attitudes of Men who Have Sex with Men on Anal Self-Examination for Early Detection of Primary Anorectal Syphilis: A Qualitative Study

“…It is not known if regular anal self-examination will result in the detection of primary anal syphilis, and therefore studies evaluating the e cacy of anal self-examination for syphilis detection are required. Anal self-examination has been studied among HIV-positive MSM aged over 50 for anal cancer detection and was shown to be a cost-effective screening method in MSM living with HIV (12,14,19,20). Our research shows men who practise receptive or versatile anal sex may be willing to adopt such a screening practice if it was recommended and came with education on what to look for during the examination, particularly signs of syphilis in the anus.…”

“…Anal self-examination, although a new concept for syphilis detection, is a practice promoted among MSM aged over 50 who are living with HIV to detect early anal cancer (12)(13)(14). A previous qualitative study among MSM living with HIV suggested that annual digital anal examination is an acceptable approach for anal cancer screening (13).…”

“…In this study, we anticipated that men living with HIV may be more familiar with the concept of anal self-examination due to the promotion of anal cancer screening in people living with HIV for aged 50 and above (13,14,21). However, not all men living with HIV might be aware of anal cancer screening using digital rectal examination.…”

Do we really need guidelines for high resolution anoscopy during the COVID‐19 pandemic? – Response

“…Whilst digital anal rectal examination (DARE) is an important first step in the evaluation of all symptomatic patients, this unfortunately has a very limited evidence base and may have significant false-negative rates [7]. In centres with highly trained practitioners, subject to robust quality assurance measures [8], HRA offers the unique ability, like colonoscopy, to detect cancers at an order of magnitude greater than those by palpation at DARE [6].…”