Acceptability of digital anal cancer screening examinations in HIV‐positive homosexual men

Abstract

ObjectivesAnal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions. MethodsWe offered anal examinations to consecutive homosexual men with HIV infection aged Ն 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule. ResultsOf 142 men who were offered enrolment in the study, 102 [72%; 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3%; 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination. ConclusionsRegular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection. Keywords: anal cancer, human papillomavirus, screening Accepted 12 March 2013 IntroductionAnal squamous cell carcinoma (SCC) is caused by oncogenic types of human papillomavirus (HPV) and is an uncommon cancer in the general community, occurring at a rate of about 1/100 000 per year [1]; however, it is much more common among HIV-positive homosexual men. A meta-analysis estimated the rate of anal cancer in this group to be 78/100 000 per year since the introduction of effective antiretroviral therapy [2].The prognosis of anal cancer is closely related to the size of tumours at diagnosis, and tumours are often diagnosed [3]. A French case series of 69 patients with tumours < 1 cm in diameter had a 100% 5-year cancer-specific survival, and 89% of patients were disease-free at 5 years [4]. In a series of HIV-infected men with anal cancer, men with tumours < 3 cm in diameter had a 5-year survival rate of 95% compared with 0% in those with tumours Ն 3 cm [5]. In a review of 128 cases of anal SCC from an Australian centre, 52% were externally visible at diagnosis, mean tumour diameter was 36 mm and 94% were Ն 1 cm [6]. The high incidence of anal cancer in homosexual men, particularly those with HIV infection, has led several investigators to develop and recommend methods of screening for the precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN), such as anal cytology, high-resolution anoscopy an...

Acceptability of high‐resolution anoscopy for anal cancer screening in HIV‐infected patients

“… reported high HRA acceptance, with or without biopsy, among a cohort that included 3% women but did not report results for women separately and did not distinguish patients having a first‐time HRA. Other studies of anal examinations for cancer screening have reported similarly high tolerability and willingness of patients to comply with screening, including studies of anal Pap smears , self‐collected anal swabs and annual anorectal digital examinations to detect anal cancer in HIV‐infected MSM .…”

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…Only one small, short term study on acceptability has been published (315). In this study 28% of those approached declined to take part.…”

Feasibility and Acceptability of Anal Self-Sampling for Human Papillomavirus Screening in HIV-Infected Patients

“…Hence, high-risk HPV and especially HPV16 detection on anal swabs could be used to identify patients at high risk of anal cancer, which could trigger regular monitoring and procedures such as high-resolution anoscopy and biopsy [11,12]. Nevertheless, anal examinations performed by clinicians can raise intimacy problems, and they are not accepted by many patients, for instance by 28% of the 142 HIV-positive MSM who were offered proctologic examination in a recent study [13]. Thus, many HIV-infected patients are not screened for anal cancer although they are at-risk individuals [2,5].…”