Anal cancer screening in women with a history of human papillomavirusrelated lower genital tract cancers:a pilot study

Objectives Women diagnosed with a history of lower genital tract cancer(LGTC)and precancer are at increased risk of anal cancer.Screening for anal cancer in a manner analogous to cervical cancer may detect precursor anal high-grade squamous intraepithelial lesions(HSILs)and prevent progression to cancer.Methods In a pilot study of anal cancer screening,women with previous LGTC and aged≥18 years in Sydney,Australia underwent a digital anorectal examination,anal swab for human papillomavirus(HPV)and p16/Ki67 testing and completeda questionnaire.Participants with positive HPV and/or p16/Ki67 results were referred for a high-resolution anoscopy(HRA)and evaluation of their HSILs.Results Of 52 participants,46 agreed to screening and 6 provided demographic information only.Median age was 46.5 years(IQR:36.059.0).Anal high-risk HPV(HRHPV)was detected in only seven(15.2%)participants(three HPV16).Eight(17.4%)had positive p16/Ki67 dual staining,with invalid results for 25(54.4%).0f 10 women referred for HRA,9 attended and 3 had HSILs,representing 6.5%of the screened population.Questionnaires were completed by 41 participants(89.1%).The majority reported that being screenedwas reassuring(97.5%)and was positive for their health(95.1%).Conclusion This pilot study demonstrated a lower-than-expected prevalence of anal HRHPV.Screening with HRHPV and p16/Ki67 staining identified anal HSILs in 6.5%of screenedwomen.Despitesomediscomfort,screeningwas viewed as beneficial by almost all participants.The utility of p16/Ki67dual staining was low,suggesting it may not be a suitable anal cancer screening methodology.