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.

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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.