Only half of screening-eligible participants living with HIV received anal cancer screenings, according to a review of data from a pair of large, urban HIV clinics in the U.S. Data indicated that 8% of screenings conducted found pre-cancerous lesions, all during anoscopies. No high-grade intraepithelial lesions were found with cytology.
About This Study
"Five-year evaluation of Anal Cancer Screening Program in Men Who Have Sex With Men with HIV at Two Academic Center Clinics" was published online on Nov. 4, 2024, in Clinical Infectious Diseases. The lead author is Amit C. Achhra, M.D., M.P.H., Ph.D., of the Section of Infectious Diseases in the Department of Medicine at Yale School of Medicine in New Haven, Connecticut.
Key Research Findings
Researchers used a retrospective chart review at two large, urban HIV centers to assess guideline-recommended frequency of anal cancer screenings in 432 men who have sex with men, are living with HIV, and are ≥ 35 years old. Current U.S. recommendations include annual cytology, followed by high-resolution anoscopy if problems are found and if the technology is readily available.
Participants were virally suppressed on antiretroviral treatment, with a median age of 57 years; 59% of participants were white, 97% on HIV treatment, and 90% had viral loads <200 copies/ml.
During a median four years of follow-up, 51% of participants were screened at least once and 26% were screened more than once; 76% of the 74 participants with abnormalities found underwent an anoscopy. High-grade squamous intraepithelial lesions, a cancer precursor, were identified in 34 participants, all through anoscopies and none through cytology. In addition, 18% of cytology samples were rated as “unsatisfactory.”
Screenings were less common among older participants (>57 years) and those who had smoked. Both characteristics are associated with an increased anal cancer risk. There was no difference in screening rates by race/ethnicity or insurance type (public vs. private).
Discussion Highlights and Implications for Practice
Study limitations reported by the researchers included reliance on electronic medical records and the study’s retrospective, observational nature.
Overall, the researchers concluded that there are many challenges implementing an anal cancer screening program, even in resource-rich settings. Lower screening rates among older participants may be related to competing priorities during clinic visits or to patient preference, the authors commented. While the study found no racial disparities in screening rates, community surveys have found such disparities, the researchers said. The difference may be due to all of the current study participants being in HIV care.
Study results suggest the need for further research into when anoscopies are warranted, how screening tests can be improved, and who should be screened and how often, the study authors concluded. Overall, implementation of anal cancer screening programs also needs to be improved, they observed.