[Anal cancer screening: who, how, and why?]

Area of Science:

• Oncology
• Epidemiology
• Public Health

Background:

• Anal cancer incidence is rising globally, especially in high-income nations.
• High-risk human papillomavirus (HR-HPV), particularly HPV16, causes over 90% of anal cancers.
• Specific populations, including individuals with HIV and organ transplant recipients, face elevated risks.

Purpose of the Study:

• To provide an overview of anal cancer screening recommendations.
• To discuss implementation strategies and challenges for anal cancer screening.
• To highlight the value of screening in high-risk populations.

Main Methods:

• Screening relies on anal cytology and HR-HPV detection.
• Novel French approach focuses on HPV16 detection for enhanced specificity.
• Anal self-sampling shows comparable performance to clinician-taken samples.

Main Results:

• Treating high-grade squamous intraepithelial lesion (HSIL) significantly reduces anal cancer progression in people with HIV.
• Anal self-sampling facilitates screening implementation.
• Ongoing research explores methylation biomarkers to optimize triage algorithms.

Conclusions:

• Targeted anal cancer screening is justified in high-risk populations.
• Improving triage algorithms and accessibility of high-resolution anoscopy (HRA) are key.
• Further research on cost-effectiveness and risk-benefit ratios is needed.