Abnormal Anal Cytology Risk in Women with Known Genital Squamous Intraepithelial Lesion

The purpose of this study was to assess the risk of abnormal anal cytology in women with known genital squamous intraepithelial lesion (SIL). 

This study evaluated 200 women with and without genital SIL who were recruited for anal Pap smears. Women who had abnormal results on equally or over atypical squamous cells of undetermined significance were classified as having abnormal anal cytology. A multiple logistic regression analysis (stepwise) was performed to identify the risk for developing abnormal anal cytology. 

Data were analyzed using the SPSS 20.0 program. The average age was 41.09 (±12.64). Of the total participants, 75.5% did not practice anal sex, 91% did not have HPV-infected partners, 92% did not have any anal pathology, and 68.5% did not have anal bleeding. More than half (57.5%) had genital SIL and a significant number developed abnormal anal cytology: 13% in the total sample and 17.4% in women with genital SIL. A significant association was observed between genital SIL and anal SIL (PR=2.46; p=0.03). In the logistic regression model, women having genital intraepithelial lesion were more likely to have abnormal anal Pap smear (aPR=2.81; p=0.02). 

This report shows that women with genital SIL must be more closely screened for anal cancer.

Below:  Normal (left) and atypical squamous cells of undetermined significance in anal cytology (right)

Full article at:   http://goo.gl/QsiG6F

By:  do Socorro Nobre M1, Jacyntho CM2, Eleutério J Jr3, Gonçalves AK4.

• 1Health Post Graduation Program, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
• 2Department of Obstetric and Gynecology, Faculdade de Medicina Souza Marques, Rio de Janeiro, RJ, Brazil.
• 3Department of Obstetrics and Gynecology, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
• 4Health Post Graduation Program, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Department of Obstetric and Gynecology, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. Electronic address: anakatherine@ufrnet.br.
• Braz J Infect Dis. 2016 Mar 29. pii: S1413-8670(16)30041-1. doi: 10.1016/j.bjid.2016.01.008. 

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Anal Cancer & Intraepithelial Neoplasia Screening: A Review

This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations.

…[T]here are populations with disproportionate prevalence of anal cancer that are more conducive to group-wide screening. Immunosuppressed patients are increasingly recognized as one of the groups at highest risk for anal cancer[13,37]. Much of this recognition has developed over the rise of the HIV/AIDS epidemic in the last three decades. Infection with HIV is associated with a 30-fold increased lifetime risk in anal cancer and a 4-fold increase in 5-year mortality[37,38]. Although sexual practices - particularly anoreceptive intercourse - have been previously associated with anal cancer, recent studies have shown that the risk of anal cancer in HIV-positive individuals exists independently of sexual practices[39,40]. The risk of anal dysplasia progression appears to correlate directly with degree of immunosuppression as measured by T cell CD4⁺ count with a cell count less than 200 cells/mm³ most closely associated with increased prevalence[41-43]. Surprisingly though increased access to highly active antiretroviral therapies has not eliminated the increased risk of anal cancer in the HIV-infected population. It is thought that immune system restoration does not entirely eliminate the increased risk of dysplastic changes and then antiretroviral treated patients are living longer thereby increasing the lifetime interval risk of disease incidence[44]...

Below:  San Francisco algorithm for anal cancer screening of high-risk patients. ASC-US: Atypical squamous cells of undetermined significance; LSIL: Low-grade squamous intraepithelial lesions; HSIL: High-grade squamous intraepithelial lesions; Pap: Papanicolaou; HRA: High-resolution anoscopy; AIN: Anal intraepithelial neoplasia

Below:  Johns Hopkins Hospital algorithm for anal cancer screening of high-risk patients. Pap: Papanicolaou; HRA: High-resolution anoscopy; ASC-H: Atypical squamous cells of undetermined significance, cannot rule-out high-grade dysplasia; AIN I: Anal intraepithelial neoplasia I; PCP: Primary care physician; LSIL: Low-grade squamous intraepithelial lesion; AIN II: Anal intraepithelial neoplasia II; AIN III: Anal intraepithelial neoplasia III.

Full article at:  http://goo.gl/Oo7oeU

By:  Ira L Leeds and Sandy H Fang

Ira L Leeds, Sandy H Fang, Ravitch Division, Colon and Rectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, United States

Author contributions: Leeds IL and Fang SH contributed to conception and design; Leeds IL contributed to data collection and analysis, and drafting manuscript; Fang SH contributed to critical revision.

Correspondence to: Ira L Leeds, MD, MBA, Ravitch Division, Colon and Rectal Surgery, Department of Surgery, Johns Hopkins Hospital, 600 N Wolfe Street, Tower 110, Baltimore, MD 21287, United States. ude.imhj@sdeeli

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Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening

Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. 

Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai'i-based project on anal cancer screening tools. Krueger's focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. 

Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being "on the radar" of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through "real talk" (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. 

Application of strategies for health practice are specific to the Hawai'i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales.

Purchase full article at:  http://goo.gl/Ku8PX0

By:  Ka'opua LS1, Cassel K2, Shiramizu B3, Stotzer RL4, Robles A4, Kapua C5, Orton M5, Milne C4, Sesepasara M5.

• 1University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA lskaopua@hawaii.edu.
• 2University of Hawai'i Cancer Center, Honolulu, HI, USA.
• 3University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA.
• 4University of Hawai'i-Ma-noa, Honolulu, HI, USA.
• 5Life Foundation of O'ahu, Honolulu, HI, USA. 

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Asymptomatic Anal Sexually Transmitted Infections in HIV-Positive Men Attending Anal Cancer Screening

BACKGROUND:

HIV-positive men who have sex with men (HIV+MSM) have an increased risk for anal dysplasia and for sexually transmitted infections (STIs).

OBJECTIVES:

We determined the positivity rate of Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), Mycoplasma genitalium (MG) and syphilis in HIV+MSM participating in an anal cancer screening (ACS)-program.

METHODS:

852 intraanal swabs were collected from 503 HIV+MSM between 2012 and 2014. Anal cytology and PCR-assays for human papillomavirus (HPV)-, CT-, NG- and MG-detection were performed. The syphilis status was determined serologically. Risk factors for STIs were explored by multiple logistic regression analysis.

RESULTS:

20.7% (104/503) of the patients had a STI other than HPV within the study period. CT was found in 10.9%, followed by NG (8.9%), and MG (4.2%). Early syphilis was detected in 4.6% and past syphilis in 44.5% of the HIV+MSM. 18 patients (3.6%) had more than one STI episode. 90.6% of the 127 STI cases were asymptomatic. Age, anal HPV infection, abnormal anal cytology, and previous syphilis were risk factors for STI.

CONCLUSIONS:

Anal STIs are frequent and mostly asymptomatic in HIV+MSM participating in ACS. STI-screening should be incorporated in ACS-programs for HIV+MSM. This article is protected by copyright. All rights reserved.

Purchase full article at:   http://goo.gl/NEu0K1

By:  Fuchs W1, Kreuter A1, Hellmich M2, Potthoff A1, Swoboda J3, Brockmeyer NH1, Wieland U4.

• 1Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
• 2Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Str. 62, 50924, Koeln, Germany.
• 3Institute of Cytology, Koblenzer Strasse 121 - 123, 53177, Bonn, Germany.
• 4National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, Uniklinik Köln, University of Cologne, Fuerst-Pueckler-Str. 56, 50935, Koeln, Germany.

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