Anal cancer is associated with human papillomavirus (HPV) infection, and some women are at increased likelihood of have both diseases.1
HPV is associated with anal cancer, a cancer more common among women. In 2014 alone, 7200 cases of anal cancer were noted with 4500 in women. “We believe that certain women with a history of an HPV-related genital infection would benefit greatly from anal cancer screening,” said Katina Robison, MD, of the women’s oncology program at Women & Infants Hospital and assistant professor and co-director of colposcopy at The Warren Alpert Medical School of Brown University in Providence, Rhode Island, and first author of the study.
Among men and women who are HIV-positive and men who have sex with men, anal cancer screening with anal cytology is routinely performed. Anal cancer is 5 times more likely in women with a history of cervical, vaginal, or vulvar cancer. Therefore, Robison sought to evaluate the feasibility of screening HIV-negative women with anal cytology and HPV testing.
From December 2012 to February 2014, 273 women were recruited for anal cytology and HPV genotyping. All women with abnormal anal cytology were referred for high-resolution anoscopy. Biopsies were also obtained at the discretion of the colorectal surgeon.
The study participants were divided into 2 groups: the high-risk group, 190 women with a history of cervical, vaginal, or vulvar cancer, and the low-risk group, 83 women with no history of cancer, dysplasia, or abnormal Pap smears.
Abnormal anal cytology was found in 40% of the high-risk group and 21.7% of the low-risk group. High-risk HPV was found in 20.8% of the patients in the high-risk group but only in 1.2% of the low-risk group.
Among the women who underwent anoscopy, no anal dysplasia was detected in the low-risk group, whereas 13.4% of the high-risk group had anal dysplasia.
The authors conclude that HIV-negative women who are high-risk should be considered for anal cancer screening. This includes women with a history of lower genital tract neoplasia, anal high-risk HPV, and anal intraepithelial neoplasia.
1. Robison K, Cronin B, Bregar A, et al. Anal cytology and human papillomavirus genotyping in women with a history of lower genital tract neoplasia compared with low-risk women. Obstet Gynecol. 2015;126(6):1294-1300.