Uptake and Predictors of Anal Cancer Screening in Men Who Have Sex With Men

Abstract

OBJECTIVES To understand attitudes about and acceptance of anal Pap screening among men who have sex with men (MSM). METHODS 1742 MSM in the Multicenter AIDS Cohort Study (MACS) were offered free anal Pap screening (cytology) and reported history of, attitudes about, and experience with anal Pap screening. Predictors of declining screening were explored with multivariate logistic regression. RESULTS A history of ever having anal Pap screening was uncommon among HIV-uninfected MSM, but more common among HIV-infected MSM (10% vs. 39%, p<0.001). Most participants expressed moderate or strong interest in anal Pap screening (86%), no anxiety about screening (66%), and a strong belief in the utility of anal Pap screening (65%). Acceptance of anal Pap screening offered during this study was high (85%) across all four U.S. study sites. Among those screened, most reported it was not a big deal, or not as bad as expected, while 3% reported it was scary. Declining to have anal Pap screening was associated with Black race, anxiety specifically about the screening, and low interest in screening, but not age or HIV status. CONCLUSIONS This study demonstrated high acceptance of anal Pap screening among both HIV-infected and HIV-uninfected MSM across four U.S. study sites.

Gay and Bisexual Men’s Willingness to Use a Self-Collected Anal Cancer Screening Test

“…The proportion of men willing to use a self-collected test was similar to or higher than those previously reported for physician-collected Pap tests. 16,24 The possibility that men may prefer a self-collected home test is supported by our findings that Study I men were more willing to use the self-collected test than to get a physician-collected Pap that cost $150 and that fewer than a third of Study II participants indicated they would rather go to a doctor to get screened for anal cancer as a concern about self-testing. This is consistent with the literature on cervical cancer screening, which has shown that allowing women to self-collect HPV samples improves participation in screening programs.…”

“…17 Similarly, D’Souza et al found that belief in the utility of anal Pap tests was associated with acceptance of a free test among MSM in bivariate analyses, but the association was not significant in their multivariate model. 24 It is possible that test effectiveness is more important to men when considering a home-based test, as a test performed by a physician may be assumed to have some minimal level of effectiveness. This idea is supported by qualitative work showing some people worry that home-based STI tests are less accurate and our own findings that the majority of men in Study II had concerns about the self-collected test’s accuracy and their ability to perform it correctly.…”

Exploring the Perceptions of Anal Cancer Screening and Behaviors among Gay and Bisexual Men Infected with HIV

“…24,25 Among those who were aware of HPV infection, most knew only about the connection between HPV infection and cervical cancer in women. These findings highlight the need to correct this perception and inform communities that HPV infection is a universal health issue and can cause various cancers that affect both men and women.…”

Factors associated with anal cancer screening follow-up by high-resolution anoscopy

“…This study also showed that only 5% of MSM report having an anal Pap test within the last 6 months, and only 12% reported intention to seek anal cancer screening in the next 6 months. Lifetime history of anal Pap screening is uncommon among MSM who are HIV infected (39%) and even less common among HIV-uninfected MSM (10%) 17. Poor screening adherence is associated with low knowledge as well as lack of concern regarding anal cancer 19.…”

“…We assessed adherence to the recommended 6-month follow-up schedule after a HRA-based HSIL diagnosis by analysing statistical factors in a binary logistic regression model with variables that either (1) had a p value of <0.05 in bivariate correlations15 16 or (2) were determined to be important for anal cancer screening engagement based on the existing literature (ie, age and race/ethnicity) 17…”