Jeff thanks for the information, I believe we met at the comorbidities conference in NY last year. I hope ANCHOR provides the well needed evidence on outcomes of anal dysplasia and the value of screening. There are many retrospective studies suggesting progression from HGAIN to anal cancer but ANCHOR will probably be the most important prospective study looking at profession and outcomes of screening and treatment vrs bi screening.
Continue, with the great work.
Currently, there are insufficient data regarding the natural history of HPV infection, and the evolution of anal dysplasia, as well as data regarding the efficacy of anal Pap smears and subsequent interventions for the prevention of anal cancer. This data would be needed to provide recommendations for the use of anal Pap screening in individuals (MSM and women) who have engaged in anal sex. The prevalence of abnormal Pap smears is high in these populations (particularly in individuals who are HIV+), as is the finding of histologically-confirmed, high-grade disease. However, it is not known whether treating the high-grade disease prevents anal cancer. In the meantime, some experts perform anal Pap testing and high-resolution anoscopy (HRA) on their patients as part of regular clinical care. If an anal Pap program is embarked upon, it is important to set up a system of follow-up for abnormal anal Pap tests (i.e., define referral patterns) prior to initiation of the program, as the frequency of abnormal Pap tests (particularly among HIV+ MSM) is high."
Faber, Mette T., et al. "Risk of anal cancer following benign anal disease and anal cancer precursor lesions: A Danish nationwide cohort study." Cancer Epidemiology and Prevention Biomarkers 29.1 (2020): 185-192.Leonard
Faber, Mette T., et al. "Risk of anal cancer following benign anal disease and anal cancer precursor lesions: A Danish nationwide cohort study." Cancer Epidemiology and Prevention Biomarkers 29.1 (2020): 185-192.
Hi David,Despite uncertainties in the progression rate of high grade anal dysplasia (HSIL) to anal squamous cell cancer, there is clear evidence that anal SCC incidence is much higher in people living with HIV, esp. with anal receptive intercourse. There is also some evidence that anal cancer screening can have an impact on anal cancer incidence and stage of diagnosis. The ANCHOR study is an ongoing randomized trial to evaluate the impact of HSIL treatment on anal cancer incidence.
There are several algorithms for anal cancer screening and most start with anal cytology. However, you would need to be able to refer patients with abnormal results for high-resolution anoscopy (HRA). Do you know whether there is any provider in your area offering who is trained in HRA? The University of San Francisco has a website on anal cancer screening which includes a list of HRA providers by state. I think in Houston Baylor College may offer HRA, Elizabeth Chiao is an expert.Best wishes,Ulrike