Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines: practitioners’ perspectives

Koskan, Alexis; Brennhofer, Stephanie; Helitzer, Deborah

doi:10.1007/s10552-019-01209-8

Cited by 21 publications

(15 citation statements)

References 27 publications

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“…[21][22][23][24][25] Recently, researchers have begun to focus on the role of anal HPV screening and secondary prevention for HIV-positive and HIV-negative MSM as a method of reducing anorectal neoplasm morbidity and mortality. 7,9,[26][27][28][29][30][31][32][33][34] Though no national guidelines regarding who should be screened, how often screening should occur, or the optimal treatment modalities for anal dysplasia exist, 14,[35][36][37] the currently accepted approach to anal HPV screening and management is modeled after approaches taken to screening and management for cervical dysplasia, which is accomplished through routine Papanicolaou cytological screening ("Pap smears") followed by colposcopy of the cervix to visualize and treat dysplastic lesions. 38,39 Patients at risk for anal dysplasia are typically first screened through self-or practitioner-collected anal/rectal swabs, and those with abnormal cytological results, including high-grade squamous intraepithelial lesions (HSIL), low-grade squamous intraepithelial lesions (LSIL), or atypical squamous cells of undetermined significance (ASCUS), are referred for further evaluation using high-resolution anoscopy (HRA).…”

Section: Introductionmentioning

confidence: 99%

“That’s Only for Women”: The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA)

Finneran

Peretz

Blemur

et al. 2021

J Int Assoc Provid AIDS Care

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Gay, bisexual, and other men who have sex with men (MSM) experience disproportionately high burdens of Human Papilloma Virus (HPV)-associated anal cancers. Recent focus has shifted to anorectal cancer prevention through high-resolution anoscopy (HRA); however, little is known about sexual minority men’s perceptions, attitudes, or beliefs regarding HRA. We conducted 4 qualitative Focus Group Discussions (FGDs) (n = 15) with sexual minority men, focusing on their beliefs, attitudes, and perceptions of undergoing HRA. Participants discussed their experiences of HPV/HRA as influenced by both their gender and sexuality, including unawareness of HPV disease as a male health issue, challenges relating to female-oriented HPV/HRA language, conception of HPV/HRA as related to prostate health, and connecting their sexual behavior identification as “bottoms” to their need for HRA. As efforts to improve HRA knowledge, access, and uptake among sexual and gender minority communities increase, special attention should be paid to language and messaging choices around HRA.

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Section: Introductionmentioning

confidence: 99%

“That’s Only for Women”: The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA)

Finneran

Peretz

Blemur

et al. 2021

J Int Assoc Provid AIDS Care

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“…Providers of various medical subspecialties caring for people living with HIV (PLWH) have initiated AC screening modeled after cervical cancer screening programs, most commonly starting with a digital anorectal exam (DARE) and anal cytology testing from Papanicolaou smear, followed by high-resolution anoscopy (HRA) for abnormal cytology results and treatment of high-grade precancerous lesions. 3,4 HIV providers at our institution offer specialty and primary care for approximately 2800 adult PLWH across 3 clinics. As of 2013, an AC screening program and access to screening HRA in the outpatient setting were lacking.…”

Section: Introductionmentioning

confidence: 99%

Establishing an Anal Cancer Screening Program in an Outpatient HIV Clinic: Referral Patterns and Patient Perceptions Survey

Sowah

Schmalzle

Khambaty

et al. 2020

J Int Assoc Provid AIDS Care

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People living with HIV are at high risk for anal cancer (AC); however, the impact of screening for and treatment of precancerous anal lesions on AC incidence remains uncertain. In 2013, we conducted a survey of HIV providers evaluating the perceived need for an institutional AC screening program. Based on an overwhelmingly positive response, we established a dedicated AC screening clinic (including provision of high-resolution anoscopies) embedded within the institutional HIV clinic. Here, we describe that referral of high-risk patients in the first 3 years was lower than expected. Referral patterns suggest that screening practices vary widely among HIV providers within the institution. Anal cancer clinic patients who completed a perception survey rated the value of AC screening as high, with perceived positive health impact, and identified their providers as the main source of information on AC and AC screening. Our findings imply remaining provider-related barriers to AC screening.

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“…There is still a lack of consensus recommendations for anal cancer screening in those at highest risk. Health care professionals providing anal cancer screening most often use anal cytology [11] and require an abnormal anal cytology prior to performing HRA in asymptomatic patients [12]. The sensitivities of anal and cervical cytology are comparable [13,14], and the sensitivity of anal cytology for the detection of anal HSIL in immunosuppressed populations (who could benefit more from screening) has been shown to be high [14].…”

Section: Introductionmentioning

confidence: 99%

Recommendations Favoring Anal Cytology as a Method for Anal Cancer Screening: A Systematic Review

Albuquerque

Rios

Schmitt

2019

Cancers

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Clinicians are increasingly facing the decision of performing anal cancer screening in high-risk groups. Anal cytology is commonly the first approach. We systematically reviewed recommendations favoring anal cytology for anal cancer screening. Three databases were searched: PubMed, Scopus, and Embase, from January 2007 to 12 September 2019. The references cited by the retrieved articles and the websites of relevant organizations were also searched without language restrictions. Studies reporting guidelines from regional or national societies, institutes, or groups were included. Eight papers met the inclusion criteria and were selected, five were from the United States of America (USA) and three from Europe. There were no national recommendations published. There was one guideline specifically for solid-organ transplant recipients. The other seven targeted HIV-positive patients, with HIV-positive men who have sex with men (MSM) included as a screening group in all of these. Two recommendations favored screening in all HIV-positive patients. Five recommendations targeting HIV-positive patients made considerations about the cytology follow-up, recommending at least annual cytology in case of a normal result, and in case of squamous cytological abnormalities, a referral for anoscopy/high-resolution anoscopy. There were no recommendations for upper and lower age limits for screening. In conclusion, several societies recommend anal cancer screening using anal cytology in HIV-positive MSM patients. There is a lack of screening recommendations for other high-risk groups, with only one society recommending screening in transplant recipients.

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Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines: practitioners’ perspectives

Cited by 21 publications

References 27 publications

“That’s Only for Women”: The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA)

“That’s Only for Women”: The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA)

Establishing an Anal Cancer Screening Program in an Outpatient HIV Clinic: Referral Patterns and Patient Perceptions Survey

Recommendations Favoring Anal Cytology as a Method for Anal Cancer Screening: A Systematic Review

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