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Published on: June 8, 2020
Screening for Anal Cancer in Women
Anna-Barbara Moscicki1, Teresa M Darragh, J Michael Berry-Lawhorn
11Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA; 2Department of Clinical Pathology, University of California, San Francisco, CA, USA; 3Division of Hematology Oncology, University of California San Francisco, CA, USA; 4Douglass Hanly Moir Pathology, Sydney, Australia; 5Division of Women's Reproductive Healthcare, Department of OB/GYN, School of Medicine, University of Alabama at Birmingham, AL, USA; 6Florida Hospital for Women, Florida Hospital System, University of Central Florida College of Medicine, FL, USA; 7Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA; 8Department of Obstetrics and Gynecology & Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY; 9Icahn School of Medicine at Mount Sinai, New York, NY, USA; 10Anal Neoplasia Clinic, Research and Education (ANCRE) Center, University of California, San Francisco, CA, USA; 11College of Medicine, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA; 12Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA; 13Colon and Rectal Surgery, Stanford University School of Medicine, Stanford Hospital and Clinics, Stanford, CA, USA; 14School of Nursing, University of California, Los Angeles, CA, USA; 15Department of Infectious Diseases, University of California, San Francisco, CA, USA.
Objective:
The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV), and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goals were to summarize the literature on anal cancer, HSIL, and HPV infection in women and to provide screening recommendations in women.
Methods:
A group of experts convened by the American Society for Colposcopy and Cervical Pathology and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL, and anal cancer in women.
Results:
Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with human immunodeficiency virus-infected women and those with a history of lower genital tract neoplasia at highest risk compared with the general population.
Conclusions:
While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and required to have digital anorectal examinations to detect anal cancers. Human immunodeficiency virus-infected women and women with lower genital tract neoplasia may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL.
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