Anal Cancer Screening Practices Among Higher-Risk Populations in an Academic Medical System.

Area of Science:

• Oncology
• Public Health
• Epidemiology

Background:

• Anal cancer disproportionately affects specific populations, including people living with HIV (PWH), those with condyloma acuminata, human papillomavirus-associated gynecologic dysplasia/cancers, and solid organ transplant recipients.
• Despite expert recommendations for anal cancer screening in these higher-risk groups, current screening practices are not well understood.
• This study investigates anal cancer screening patterns within an academic medical system offering high-resolution anoscopy.

Purpose of the Study:

• To characterize anal cancer screening practices among populations at higher risk for the disease.
• To identify factors associated with receiving anal cancer screening within an academic medical system.
• To evaluate the uptake and outcomes of anal cancer screening in vulnerable patient groups.

Main Methods:

• Retrospective analysis of outpatient clinical data from January 2015 to August 2022 across three academic medical system sites.
• Inclusion of patient demographics, medical comorbidities, and anal cytology and human papillomavirus (HPV) testing results.
• Statistical analysis using chi-squared tests and logistic regression to determine associations between patient characteristics and screening.

Main Results:

• Overall, only 6.3% of the 7654 patients received anal cytology screening. Screening rates varied by risk group: 21.7% for PWH, 13.8% for condyloma acuminata, 1.1% for gynecologic cancers, and 0.5% for solid organ transplants.
• Black patients were 46% less likely to be screened than White patients, and cisgender women were 73% less likely than cisgender men.
• Among those screened, 37.5% received only one screening, and 70.5% had abnormal cytology results on at least one occasion.

Conclusions:

• Anal cancer screening rates remain low, even among people living with HIV (PWH), with other high-risk groups experiencing even lower uptake.
• Significant disparities in screening exist, with Black patients and women being less likely to receive anal cancer screening.
• There is an urgent need to develop and implement strategies that promote equitable anal cancer screening practices for all at-risk populations.