Is screening for anal squamous intraepithelial lesions in women with genital human papillomavirus intraepithelial lesions necessary?

Abstract

Introduction: There seems to be a fairly close relationship between genital and anal lesions associated with human papillomavirus (HPV) and with the pathogenesis of malignancies in such sites. Objective: This review seeks to analyze published papers that suggest the necessity for anal intraepithelial lesions screening in women with HPV genital intraepithelial lesions. Methods: A systematic review of original research published between 2001 and 2014 was performed in the databases PubMed, HighWire, Cochrane Library and Google Scholar. The keywords for the search were: "screening" or "early detection of cancer" and "anus" or "anus diseases" or "neoplasms anus" and "woman" or "women" and "HPV" or "DNA probes, HPV". Results: 1,203 articles were selected in the first search. After the reviewers applied exclusion and inclusion criteria and analyzed the papers, 15 were selected to compose this review. Most of them showed higher rates of anal intraepithelial lesions in women with genital intraepithelial lesions than in regular women. We also found a correlation between genital neoplasms and anal infection by oncogenic HPV types and the role of the virus in the pathogenesis of anal cancer. Conclusion: Screening for anal lesions in women with HPV genital lesions should be indicated, and further studies are required to determine the best methods.

Anal cytology in immunocompetent patients with high-grade intraepithelial neoplasia (CIN II and CIN III)

“…In contrast, two other studies which seek to determine the prevalence of precursor lesions of anal cancer in women with genital neoplasia, carried out in Brazil, didn't show any considerable association between anal intercourse and anal lesion precursor to neoplasia [14,15]. A considerable association between alcohol beverages consumption and tobacco use was found between patients of the study group.…”

Anal High-risk HPV and Liquid-based Cytology of Immunocompetent Brazilian Women with Genital High-risk HPV

“…10 Women with a history of a genital squamous intraepithelial lesion (SIL) are at increased risk for anal HSILs and cancer as compared with the general population, and some authors recommend anal cytological screening for these women. [10][11][12][13] In Brazilian women, there are few studies on the prevalence of anal Hr-HPV and anal SILs. The purpose of this study was to evaluate the frequency of Hr-HPV infection and abnormal anal liquid-based cytology among immunocompetent women with and without a genital SIL.…”

“… 10 Women with a history of a genital squamous intraepithelial lesion (SIL) are at increased risk for anal HSILs and cancer as compared with the general population, and some authors recommend anal cytological screening for these women. 10 11 12 13 …”