38. Anal cancer screening in HIV primary care: uptake and outcomes
Irving E. Salit A , Sandra Blitz A B , Evan Collins A B , Banita Aggarwal A , Janet Raboud A B , Jill Tinmouth B C , Colin Kovacs B D , Denis Conway A , Malcolm Hedgcock D , Barry Merkley D , David Fletcher D and Liviana Calzavara B EA University Health Network, Toronto, ON, Canada.
B University of Toronto, Toronto, ON, Canada.
C Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
D Maple Leaf Medical Clinic, Toronto, ON, Canada.
E Dalla Lana School of Public Health, Toronto, ON, Canada.
Sexual Health 10(6) 588-588 https://doi.org/10.1071/SHv10n6ab38
Published: 22 November 2013
Abstract
Background: Anal cytology (Pap tests) plus high-resolution anoscopy (HRA) as required are felt to be the optimal approach to anal cancer screening. We present preliminary results from STANDOUT, a study of acceptability and outcomes of anal cancer screening of HIV+ MSM in primary care practices. Methods: All previously unscreened HIV+ MSM from 9 HIV primary care practices, were invited by email or letter to receive anal cancer screening. Responders had anal cytology done at specially arranged or routine clinic visits. Those with high-grade squamous intraepithelial lesions (HSIL) on anal cytology were offered HRA to assess for anal intraepithelial neoplasia (AIN). Those with AIN 2/3 on biopsy were randomised to receive trichloroacetic acid (TCA) or infrared coagulator (IRC) treatments. Results: 1733 patients were invited and 921 (53%) agreed to have anal cytology done. Among those screened, 3 had unsatisfactory samples; 596 (65%) had normal cytology, 253 (27%) had low-grade squamous intraepithelial lesions (LSIL) and 69 (7.5%) had HSIL. HRA results are available in 64: 41 (64%) had histologic high-grade disease (29 had AIN2 and 12 had AIN3). Those with AIN 2/3 were randomised to receive treatment with TCA (16 patients) or IRC (18 patients). Treatment successes at 3 months were 6 of 15 patients for TCA (40%) and 11 of 16 patients for IRC (69%). Conclusions: In this sample of HIV+ MSM, about half of those invited for anal cancer screening agreed to have it done. Most with HSIL had histological high-grade disease and were treated. IRC was more successful than TCA at ablating high-grade disease.
