Perianal Condylomas, Anal Squamous Intraepithelial Neoplasms and Screening: A Review of the Literature

Abstract

Anal squamous intraepithelial lesions (ASILs) are the precursors to anal cancer. Human papillomavirus infection has a direct link to ASIL formation and is responsible for up to 80% of anal cancers. But while much importance has been focused on targeting cancer precursors in the cervix, relatively little concern has been afforded to the anal canal. With the advent of cervical Pap smear screening in various regions, the incidence of cervical cancer has declined. However, marked similarities in the biological and pathological profiles of cervical cancer and anal cancer mean that anal cancer should be preventable in the same way – by curbing the progression of ASIL to cancer. This article explores the literature on ASILs and the growing problem of anal cancer in the community, along with the literature surrounding the current progress towards implementing a screening programme for ASIL in the future.

Human Papillomavirus and Anorectal Carcinoma Knowledge in Men Who Have Sex With Men

“…Although epidemiologic data have suggested that the prevalence of anorectal dysplasia and carcinoma in this population were similar to that of dysplasia and cancer of the cervix in women before the widespread implementation of cervical Papanicolau (Pap) screenings (Oon & Winter, 2010), more recent studies have indicated that anal cancer is now more common than cervical cancer in women (Goldstone & Moshier, 2010).…”

“…Because men who have HPV do not always have symptoms of the disease, the absence of visible genital lesions during a physical examination may preclude an accurate diagnosis (Bertram & Niederhauser, 2008;Oon & Winter, 2010). High rates of anal cancer have recently been observed in gay and bisexual men in whom high rates of risky sexual behavior (e.g., receptive anal intercourse with multiple partners, smoking, drug use) along with concurrent HPV infection were also prevalent (Lindsey et al, 2009;Reed et al, 2010).…”

Prevalence of Anal Dysplasia in Patients With Inflammatory Bowel Disease

“…1 Current screening for anal dysplasia is limited to human immunodeficiency virus (HIV)-positive men who have sex with men. 2 Guidelines have not been established for other potential at-risk patient populations.…”

Perianal Skin Conditions

“…Anal smears and anoscopy are under investigation for AIN screening in high-risk subjects [ 70 ]. There is no treatment for HPV infection, but locally destructive treatments are used for warts and may reduce infectivity.…”