Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines

practitioners’ perspectives

Alexis Koskan, Stephanie A. Brennhofer, Deborah Helitzer

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalCancer Causes and Control
DOIs
StatePublished - Jan 1 2019

Fingerprint

Anus Neoplasms
HIV
Guidelines
Digital Rectal Examination
Delivery of Health Care
Papanicolaou Test
Frustration
Anal Canal
Population
Neoplasms
Biomarkers
Interviews
Biopsy
Equipment and Supplies
Infection
Research

Keywords

  • Anal cancer
  • Anal intraepithelial neoplasia
  • Human immunodeficiency virus
  • Human papillomavirus

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

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title = "Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines: practitioners’ perspectives",
abstract = "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 immunodeficiency virus, Human papillomavirus",
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AB - 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.

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