47. The infancy of TasGANS: establishing an anal dysplasia screening program for women in a regional Australian setting

Abstract

Background: Epidemiological studies around the world concur that the majority of anal cancers arise in women. There is also evidence that the prevalence of anal precursor (ASIL) lesions is significantly higher in women with a history of cervical and other gynaecological neoplasia. With this in mind, we set out to pilot a regional anal screening program for women attending follow up at colposcopy and gynaecological oncology clinics. As well as describing the coprevalence of ASIL lesions, we also sought to elicit determinants of ASIL in this particular subgroup of at-risk women. Methods: Eligible women were approached to undergo anal exfoliative cytology and complete a basic clinical and demographic questionnaire. Gynaecologists were given face-to-face and written instructions in the technique of anal smear testing. Several quality indicators were measured. Results: Over a 15-month period, 138 eligible women were approached, of whom 96 (69.6%) consented to participate. Of cytology results thus far available, 30.4% revealed a degree of ASIL warranting high resolution anoscopy (HRA). Only one case had insufficient cellularity, although in approximately one-third of cases there was an absence of glandular cells in the smear. Possible explanations for these data, and possible solutions, will be proffered. Conclusions: The prevalence of ASIL in women with prior gynaecological neoplasia appears to justify a targeted screening program, although several logistic barriers need to be addressed. To mainstream anal neoplasia screening within the public health sector requires considerable buy-in from local stakeholders, and a cultural shift within the Women’s Health community.