Anal Cancer Screening Prevalence in U.S. Cities and Factors Associated With Screening

Annual anal cancer screening for sexual minority men and transgender women with HIV has been recommended by experts for more than 15 years and is now endorsed by the U.S. Department of Health and Human Services. The prevalence of anal cancer screening in these populations was estimated in the Chicago, Houston, and Milwaukee metropolitan areas, which are in U.S. regions with the highest anal cancer incidence among people with HIV.

Survey responses collected in 2020-2022 from individuals in the Prevent Anal Cancer studies were analyzed. The prevalence of anal cytology within the prior year and any history of high-resolution anoscopy was stratified by HIV status in individuals of screening age (≥35 years for people with HIV and ≥45 years if HIV negative). Factors associated with cytology and high-resolution anoscopy were assessed using logistic regression. Barriers to anal cancer screening were assessed and stratified by HIV status.

A total of 540 individuals were of screening age and reported HIV status and anal cytology screening within the prior year. Most participants (84.4%, 456 of 540) were aged ≥45 years, and 52.0% (281 of 540) reported having HIV. The prevalence of anal cytology in the prior year was 8.3% (45 of 540) and did not differ by HIV status. Only a history of anal warts was associated with cytology (AOR=2.57, 95% CI=1.31, 5.06). A history of undergoing high-resolution anoscopy among people with HIV differed by metropolitan area: 35.9% (28 of 78) in Chicago, 18.1% (27 of 149) in Houston, and 20.8% (11 of 53) in Milwaukee (p=0.001). People with HIV had more than double the odds of reporting a history of high-resolution anoscopy (AOR=2.36, 95% CI=1.32, 4.22) than HIV-negative people.

Among communities highly vulnerable to anal cancer, screening uptake was low and differed by metropolitan area. Interventions are urgently needed at clinical, provider, and individual levels to increase uptake.