Anal cancer screening in HIV-infected patients: Is it time to screen them all?

Alexander O. Mallari, Theresa M. Schwartz, Amneris E. Luque, Pamela S. Polashenski, Stephen M. Rauh, Roberto B. Corales

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

BACKGROUND: Annual screening for anal cancer is recommended only for HIV patients at increased risk: men who have sex with men, individuals with a history of anogenital warts, and women with cervical dysplasia. OBJECTIVE: The aim of this study was to examine the screening outcomes between HIV populations with and without these risk factors. METHODS: We reviewed the records of all HIV patients referred for anal cytology and high-resolution anoscopy from June 2009 to June 2010. Patients were stratified into an increased-risk group or a standard-risk group. MAIN OUTCOME: Of the 329 evaluable patients, 285 (89.8% men, 10.2% women, mean age 46 ± 10 years) were classified to the increased-risk group, whereas 44 (72.7% men, 27.3% women, mean age 52 ± 8 years) were included in the standard-risk group. Male sex, white race, sexual orientation, past and current receptive anal intercourse, noncompliance with condom use, and absence of a new sexual partner were significantly different in the increased-risk group in comparison with the standard-risk group. In the increased-risk group, 187 (66.5%) patients had biopsy-proven dysplasia of which 118 (42.0%) had high-grade disease. In the standard-risk group, 15 (34.9%) patients had biopsy-proven dysplasia of which 7 (16.3%) had high-grade disease. Cytology detected biopsy-confirmed high-grade dysplasia only in 23 of 118 (19.5%) patients in the increased-risk group and in 2 of 7 (28.6%) patients in the standard-risk group. Kappa agreement in detecting high-grade disease was low for both increased-risk and standard-risk groups: 0.16 (95% CI 0.07-0.23) and 0.40 (95% CI 0.02-0.40). LIMITATIONS: Our study is a chart-based retrospective review of data with a small female population. Histology reports came from 2 different laboratories. CONCLUSION: High-grade anal dysplasia was prevalent even among HIV patients who only have standard risk factors. Anal cytology and high-resolution anoscopy have poor agreement. We suggest considering annual screening by using high-resolution anoscopy in addition to cytology for all HIV patients regardless of risk factors.

Original languageEnglish (US)
Pages (from-to)1244-1250
Number of pages7
JournalDiseases of the Colon and Rectum
Volume55
Issue number12
DOIs
StatePublished - Dec 1 2012

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Anus Neoplasms
Early Detection of Cancer
HIV
Cell Biology
Biopsy
Uterine Cervical Dysplasia
Warts
Sexual Partners
Condoms
Sexual Behavior
Population

Keywords

  • Anal cancer
  • Anoscopy
  • Cytology
  • Dysplasia
  • HIV
  • Screening

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Mallari, A. O., Schwartz, T. M., Luque, A. E., Polashenski, P. S., Rauh, S. M., & Corales, R. B. (2012). Anal cancer screening in HIV-infected patients: Is it time to screen them all? Diseases of the Colon and Rectum, 55(12), 1244-1250. https://doi.org/10.1097/DCR.0b013e31826ab4fb

Anal cancer screening in HIV-infected patients : Is it time to screen them all? / Mallari, Alexander O.; Schwartz, Theresa M.; Luque, Amneris E.; Polashenski, Pamela S.; Rauh, Stephen M.; Corales, Roberto B.

In: Diseases of the Colon and Rectum, Vol. 55, No. 12, 01.12.2012, p. 1244-1250.

Research output: Contribution to journalReview article

Mallari, AO, Schwartz, TM, Luque, AE, Polashenski, PS, Rauh, SM & Corales, RB 2012, 'Anal cancer screening in HIV-infected patients: Is it time to screen them all?', Diseases of the Colon and Rectum, vol. 55, no. 12, pp. 1244-1250. https://doi.org/10.1097/DCR.0b013e31826ab4fb
Mallari, Alexander O. ; Schwartz, Theresa M. ; Luque, Amneris E. ; Polashenski, Pamela S. ; Rauh, Stephen M. ; Corales, Roberto B. / Anal cancer screening in HIV-infected patients : Is it time to screen them all?. In: Diseases of the Colon and Rectum. 2012 ; Vol. 55, No. 12. pp. 1244-1250.
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abstract = "BACKGROUND: Annual screening for anal cancer is recommended only for HIV patients at increased risk: men who have sex with men, individuals with a history of anogenital warts, and women with cervical dysplasia. OBJECTIVE: The aim of this study was to examine the screening outcomes between HIV populations with and without these risk factors. METHODS: We reviewed the records of all HIV patients referred for anal cytology and high-resolution anoscopy from June 2009 to June 2010. Patients were stratified into an increased-risk group or a standard-risk group. MAIN OUTCOME: Of the 329 evaluable patients, 285 (89.8{\%} men, 10.2{\%} women, mean age 46 ± 10 years) were classified to the increased-risk group, whereas 44 (72.7{\%} men, 27.3{\%} women, mean age 52 ± 8 years) were included in the standard-risk group. Male sex, white race, sexual orientation, past and current receptive anal intercourse, noncompliance with condom use, and absence of a new sexual partner were significantly different in the increased-risk group in comparison with the standard-risk group. In the increased-risk group, 187 (66.5{\%}) patients had biopsy-proven dysplasia of which 118 (42.0{\%}) had high-grade disease. In the standard-risk group, 15 (34.9{\%}) patients had biopsy-proven dysplasia of which 7 (16.3{\%}) had high-grade disease. Cytology detected biopsy-confirmed high-grade dysplasia only in 23 of 118 (19.5{\%}) patients in the increased-risk group and in 2 of 7 (28.6{\%}) patients in the standard-risk group. Kappa agreement in detecting high-grade disease was low for both increased-risk and standard-risk groups: 0.16 (95{\%} CI 0.07-0.23) and 0.40 (95{\%} CI 0.02-0.40). LIMITATIONS: Our study is a chart-based retrospective review of data with a small female population. Histology reports came from 2 different laboratories. CONCLUSION: High-grade anal dysplasia was prevalent even among HIV patients who only have standard risk factors. Anal cytology and high-resolution anoscopy have poor agreement. We suggest considering annual screening by using high-resolution anoscopy in addition to cytology for all HIV patients regardless of risk factors.",
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AU - Mallari, Alexander O.

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N2 - BACKGROUND: Annual screening for anal cancer is recommended only for HIV patients at increased risk: men who have sex with men, individuals with a history of anogenital warts, and women with cervical dysplasia. OBJECTIVE: The aim of this study was to examine the screening outcomes between HIV populations with and without these risk factors. METHODS: We reviewed the records of all HIV patients referred for anal cytology and high-resolution anoscopy from June 2009 to June 2010. Patients were stratified into an increased-risk group or a standard-risk group. MAIN OUTCOME: Of the 329 evaluable patients, 285 (89.8% men, 10.2% women, mean age 46 ± 10 years) were classified to the increased-risk group, whereas 44 (72.7% men, 27.3% women, mean age 52 ± 8 years) were included in the standard-risk group. Male sex, white race, sexual orientation, past and current receptive anal intercourse, noncompliance with condom use, and absence of a new sexual partner were significantly different in the increased-risk group in comparison with the standard-risk group. In the increased-risk group, 187 (66.5%) patients had biopsy-proven dysplasia of which 118 (42.0%) had high-grade disease. In the standard-risk group, 15 (34.9%) patients had biopsy-proven dysplasia of which 7 (16.3%) had high-grade disease. Cytology detected biopsy-confirmed high-grade dysplasia only in 23 of 118 (19.5%) patients in the increased-risk group and in 2 of 7 (28.6%) patients in the standard-risk group. Kappa agreement in detecting high-grade disease was low for both increased-risk and standard-risk groups: 0.16 (95% CI 0.07-0.23) and 0.40 (95% CI 0.02-0.40). LIMITATIONS: Our study is a chart-based retrospective review of data with a small female population. Histology reports came from 2 different laboratories. CONCLUSION: High-grade anal dysplasia was prevalent even among HIV patients who only have standard risk factors. Anal cytology and high-resolution anoscopy have poor agreement. We suggest considering annual screening by using high-resolution anoscopy in addition to cytology for all HIV patients regardless of risk factors.

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