Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines: practitioners’ perspectives (original) (raw)

2019, Cancer Causes & Control

Purpose Immunocompromised populations including people living with HIV (PLWH) suffer disproportionate burden from anal cancer, a rare cancer caused by persistent infection of the anal canal with oncogenic strains of human papillomavirus. In the US, there are no nationally adopted screening guidelines for anal cancer. In the absence of such guidelines, this study explores healthcare practitioners' screening practices for early signs of anal cancer among PLWH. Methods Between November 2017 and June 2018, the research team completed 25 interviews among a diverse sample of healthcare practitioners who provide care for PLWH. Results Providers expressed frustration that screening and treatment guidelines for anal cancer were scant, and they varied in their screening practices. The majority of providers screened PLWH for anal dysplasia via the anal Pap smear; few providers were trained and had the medical equipment to conduct high-resolution anoscopy-guided biopsies, a more sensitive and specific screening method. Others screened through digital ano-rectal examinations (DARE) and both visually and with a DARE. Participants discussed how providers may be over-treating their patients who have high-grade anal intraepithelial neoplasia (AIN) and the role of biomarkers to determine whether the lesion is carcinogenic. Conclusions Practitioners who provide care for PLWH are proactive in screening to help prevent and control anal cancer, a rare and slow-growing disease. Continuing to regularly surveil high-risk populations, particularly PLWH previously diagnosed with high-grade lesions, is critical to prevent and control anal cancer. Keywords Anal cancer • Anal intraepithelial neoplasia • Human papillomavirus • Human immunodeficiency virus Anal cancer is rare in the general population. In the United States (US), it is a cancer disparity among people who are immunosuppressed, including people living with HIV (PLWH) [1, 2]. In an analysis of 13 US cohort studies of PLWH, incidence of anal cancer was highest among HIVinfected men who have sex with men (131 per 100,000), followed by HIV-infected heterosexual men (46 per 100,000) and HIV-infected women (30 per 100,000) [2]. Also between the years 1999 and 2005, the incidence of anal cancer has continued increasing, irrespective of HIV status, by 2.1%