Psychosocial aspects of anal cancer screening: a review and recommendations

Landstra, Jodie; Ciarrochi, Joseph; Deane, Frank P.

doi:10.1071/sh11169

Cited by 13 publications

(16 citation statements)

References 38 publications

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“…These studies have been described in detail by Landstra [21] and variously report (1) no significant effect of screening on anxiety, depression or quality of life [22,23], (2) high acceptability (86%) of self-collected cytology swabs [24] and (3) high acceptability (91%) of high-resolution anoscopy [25], although 93% of patients required intervention for pain. The only data comparing DRE, cytology and HRA come from an ongoing cohort study of HIV-positive and HIV-negative homosexual men having all three procedures.…”

Section: Discussionmentioning

confidence: 99%

Acceptability of digital anal cancer screening examinations in HIV‐positive homosexual men

et al. 2013

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ObjectivesAnal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions. MethodsWe offered anal examinations to consecutive homosexual men with HIV infection aged Ն 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule. ResultsOf 142 men who were offered enrolment in the study, 102 [72%; 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3%; 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination. ConclusionsRegular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection. Keywords: anal cancer, human papillomavirus, screening Accepted 12 March 2013 IntroductionAnal squamous cell carcinoma (SCC) is caused by oncogenic types of human papillomavirus (HPV) and is an uncommon cancer in the general community, occurring at a rate of about 1/100 000 per year [1]; however, it is much more common among HIV-positive homosexual men. A meta-analysis estimated the rate of anal cancer in this group to be 78/100 000 per year since the introduction of effective antiretroviral therapy [2].The prognosis of anal cancer is closely related to the size of tumours at diagnosis, and tumours are often diagnosed [3]. A French case series of 69 patients with tumours < 1 cm in diameter had a 100% 5-year cancer-specific survival, and 89% of patients were disease-free at 5 years [4]. In a series of HIV-infected men with anal cancer, men with tumours < 3 cm in diameter had a 5-year survival rate of 95% compared with 0% in those with tumours Ն 3 cm [5]. In a review of 128 cases of anal SCC from an Australian centre, 52% were externally visible at diagnosis, mean tumour diameter was 36 mm and 94% were Ն 1 cm [6]. The high incidence of anal cancer in homosexual men, particularly those with HIV infection, has led several investigators to develop and recommend methods of screening for the precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN), such as anal cytology, high-resolution anoscopy an...

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Section: Discussionmentioning

confidence: 99%

Acceptability of digital anal cancer screening examinations in HIV‐positive homosexual men

et al. 2013

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“…worry about cancer [18,20,21,25]). There is inconsistency in evidence for psychological effects of cancerscreening processes and responses to different screening results, but there is consensus that measurement of the psychological consequences of cancer screening needs to be more standardized [20,21,[24][25][26][27].…”

Section: Psychological Consequences From Screeningmentioning

confidence: 99%

Psychological consequences of cancer screening in HIV

Landstra

Deane²,

Ciarrochi³

2013

Current Opinion in Oncology

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“…The inconsistency between studies is related to the paucity of data on which the models are based and, like several other papers in this issue, highlight the urgent need for a better understanding of the key issues such as the epidemiology and natural history of AIN. 17 The potential adverse psychosocial impact of anal cancer screening is discussed by Landstra et al 18 The review did not find that anal cancer screening significantly affected general mental health but screening does generate some increased worry about anal cancer in those screened. 18 The paper has some suggested approaches to minimise this and makes some recommendations for measuring the impact of anal cancer screening.…”

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confidence: 99%

“…17 The potential adverse psychosocial impact of anal cancer screening is discussed by Landstra et al 18 The review did not find that anal cancer screening significantly affected general mental health but screening does generate some increased worry about anal cancer in those screened. 18 The paper has some suggested approaches to minimise this and makes some recommendations for measuring the impact of anal cancer screening. 18 One topic that is not covered in this special issue is the use of prophylactic HPV vaccines in men and, specifically, their role in preventing anal cancer in MSM.…”

mentioning

confidence: 99%

“…18 The paper has some suggested approaches to minimise this and makes some recommendations for measuring the impact of anal cancer screening. 18 One topic that is not covered in this special issue is the use of prophylactic HPV vaccines in men and, specifically, their role in preventing anal cancer in MSM. 19 The efficacy of the HPV vaccines in preventing AIN in MSM is high, with a per protocol efficacy of 78% in a recent study.…”

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Why a special issue on anal cancer and what is in it?

et al. 2012

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Abstract. This editorial describes the contents of this special issue of Sexual Health devoted to anal cancer. The aim of the issue is to provide readers with information to assist them in making decisions about what to do about detecting anal cancer early in men who have sex with men with HIV. Should they be advocating screening? It discusses the epidemiology of HPV infection, anal intraepithelial neoplasia, and anal cancer in MSM, heterosexual men and women; anal cancer screening and treatment of anal cancer. And most importantly, what should be done about vaccinating boys with the HPV vaccine.Received 10 July 2012, accepted 3 September 2012, published online 27 November 2012Welcome to this special issue on anal cancer, which we commissioned because of the considerable uncertainty -and at times frank disagreement -about how to deal with the important public health issue of anal cancer in men who have sex with men (MSM). Some practitioners are advocating population-based screening of MSM, regardless of their HIV status. Others are not convinced that screening is appropriate but most of us remain quite unsure about what to do. Yet while we deliberate, rates of anal cancer appear to be increasing among MSM with HIV to levels similar to those of bowel cancer in the general population. We hope this special issue will assist you in deciding where you stand about this important public health issue.The magnitude of the problem is, perhaps, one of the most important points. Grulich et al. describe the epidemiology of anal cancer, highlighting its relatively low rate in the general population but considerably higher rate in MSM, particularly in those with HIV where it approaches~100 per 100 000. 1,2 Despite only a relatively small proportion of the population being MSM, the high rate among MSM is clearly apparent at a population level. Poynten et al. describe a much higher incidence of anal cancer in postcodes where gay men more commonly live compared with postcodes where they do not commonly live. 3 And this problem will not go away, with rates of anal cancer rising in both men and women in all countries where time trends have been described. 4 Pandey describes the anal anatomy, an understanding of which is important for interpreting examination and investigation findings, the pathogenesis of conditions such as internal haemorrhoids and the spread of metastatic anal cancer. 5 Heywood and Smith review published data on anal sexual practices and highlight the paucity of data that are available at a population level. 6 They make the important point that in many populations, perhaps twice as many heterosexuals engage in anal intercourse as homosexual men, particularly in some countries in Latin America, where heterosexual anal sex is more common. 6 They highlight the paucity of data on the frequency of anal sex and other activities such as digital stimulation, which could potentially transmit the human papillomavirus (HPV). 6 Machaleck et al. take on the task of describing the epidemiology of anal HPV infection in MSM. 7 T...

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Psychosocial aspects of anal cancer screening: a review and recommendations

Cited by 13 publications

References 38 publications

Acceptability of digital anal cancer screening examinations in HIV‐positive homosexual men

Acceptability of digital anal cancer screening examinations in HIV‐positive homosexual men

Psychological consequences of cancer screening in HIV

Why a special issue on anal cancer and what is in it?

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