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Maes‐Carballo M, García‐García M, Gómez‐Fandiño Y, Estrada‐López CR, Iglesias‐Álvarez A, Bueno‐Cavanillas A, Khan KS. Systematic review of shared decision-making in guidelines about colorectal cancer screening. Eur J Cancer Care (Engl) 2022; 31:e13738. [PMID: 36254840 PMCID: PMC9786598 DOI: 10.1111/ecc.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION We aimed to systematically evaluate quality of shared decision-making (SDM) in colorectal cancer (CRC) screening clinical practice guidelines (CPGs) and consensus statements (CSs). METHODS Search for CRC screening guidances was from 2010 to November 2021 in EMBASE, Web of Science, MEDLINE, Scopus and CDSR, and the World Wide Web. Three independent reviewers and an arbitrator rated the quality of each guidance using a SDM quality assessment tool (maximum score: 31). Reviewer agreement was 0.88. RESULTS SDM appeared in 41/83 (49.4%) CPGs and 9/19 (47.4%) CSs. None met all the quality criteria, and 51.0% (52/102) failed to meet any quality items. Overall compliance was low (mean 1.63, IQR 0-2). Quality was better in guidances published after 2015 (mean 1, IQR 0-3 vs. mean 0.5, IQR 0-1.5; p = 0.048) and when the term SDM was specifically reported (mean 4.5, IQR 2.5-4.5 vs. mean 0.5, IQR 0-1.5; p < 0.001). CPGs underpinned by systematic reviews showed better SDM quality than consensus (mean 1, IQR 0-3 vs. mean 0, IQR 0-2, p = 0.040). CONCLUSION SDM quality was suboptimal and mentioned in less than half of the guidances, and recommendations were scarce. Guideline developers should incorporate evidence-based SDM recommendations in guidances to underpin the translation of evidence into practice.
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Affiliation(s)
- Marta Maes‐Carballo
- Department of General Surgery, Breast Cancer UnitComplexo Hospitalario de OurenseOurenseSpain,Department of General SurgeryHospital Público de VerínOurenseSpain,Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
| | - Manuel García‐García
- Department of General Surgery, Breast Cancer UnitComplexo Hospitalario de OurenseOurenseSpain
| | - Yolanda Gómez‐Fandiño
- Department of General Surgery, Breast Cancer UnitComplexo Hospitalario de OurenseOurenseSpain
| | | | - Andrés Iglesias‐Álvarez
- Department of General SurgeryUniversity of Santiago de CompostelaSantiago de CompostelaSpain
| | - Aurora Bueno‐Cavanillas
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain,Instituto de Investigación Biosanitaria IBSGranadaSpain,CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain,Instituto de Investigación Biosanitaria IBSGranadaSpain
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Plotzker RE, Barnell GM, Wiley DJ, Stier EA, Jay N. Provider Preferences for Anal Cancer Prevention Screening: Results of the International Anal Neoplasia Society Survey. Tumour Virus Res 2022; 13:200235. [PMID: 35183808 PMCID: PMC9006639 DOI: 10.1016/j.tvr.2022.200235] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
Objective This study explores provider preferences regarding anal cancer screening indications, initiation age, tools, and referral threshold to high resolution anoscopy (HRA). Methods International Anal Neoplasia Society affiliates were invited to complete an online survey. Options for initiation age and tools were delineated by sub-groups. HRA referral thresholds separately queried recommendations by patient immune status. Results One hundred forty respondents participated. Although consensus was lacking with regard to specific screening initiation age, more respondents recommended younger initiation ages for men who have sex with men (MSM) living with HIV (LWH) compared with MSM not LWH (p < 0.01). “No age threshold” ranged 44-55% among sub-groups with lower genital tract disease. Cytology and digital anorectal exam (DARE) were the most frequently selected tools for all sub-groups (ranges 77-90% and 74-86%, respectively). HRA was recommended significantly more frequently for MSM LWH (58%) and patients with vulvar cancer (52%) compared to others (p < 0.01). “Any [test] abnormality” was more often selected as indication for HRA for immunocompromised (56%) and immunocompetent (46%) patients than a specific cytology test result (29%, 36% respectively). Conclusion Cytology and DARE were preferred screening tools; screening initiation age and HRA referral threshold showed less consensus. Evidence-based guidelines are needed and may lead to more consistent screening practices.
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Affiliation(s)
- Rosalyn E Plotzker
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
| | - Gregory M Barnell
- Kaiser Permanente, Oakland Medical Center, Department of Surgery, 3600 Broadway, Suite 38, Oakland, CA 94611, USA.
| | - Dorothy J Wiley
- UCLA School of Nursing, 700 Tiverton Avenue, Factor Building Room #4242, Los Angeles, CA 90095-6918 USA.
| | - Elizabeth A Stier
- Boston University School of Medicine, Boston Medical Center, 771 Albany Street, Dowling 4, Boston, MA 02118 USA.
| | - Naomi Jay
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
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Ejaz M, Mubarak M, Ali TS, Andersson S, Ekström AM. Human papillomavirus-associated anal squamous intraepithelial lesions in men who have sex with men and transgender women living with and without HIV in Karachi Pakistan: implications for screening and prevention. BMC Infect Dis 2021; 21:1163. [PMID: 34789177 PMCID: PMC8597180 DOI: 10.1186/s12879-021-06850-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Anal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan. METHODS We conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS Control Program in Karachi. The study enrolled MSM and transgender women aged greater-than-and-equal-to-18-years who reported anal sex in the preceding 6 months. We collected two anal samples for liquid-based cytology and HPV type testing by PCR, and socio-demographic and behavioral data were collected through face-to face interviews. ASIL and its associations with biological and behavioral risk factors were analyzed through Cox regression for prevalence ratios (PR) and corresponding 95% confidence intervals (CIs). RESULTS Out of 271 qualifying participants, 79% were MSM and 21% transgender women. The mean age was 28.8 (± 8) years. Almost 35% (93/271) of the study population had ASIL detected, ASIL was significantly more common among participants living with HIV than in HIV negative ((50/118) 42.4%; vs. (43/153) 28.1%) (p ≤ 0.001). Among ASIL, 66% (61/93) had low-grade squamous intraepithelial lesions (LSIL), and 3.6% (3/93) had high-grade squamous intraepithelial lesions (HSIL). The overall, HPV16 positivity was 35.5% (33/93) among all abnormal anal lesions and all 3 HSIL were HPV16 positive, however, HPV16 positivity could show its association with ASIL detection in univariate model only (PRcrude: 2.11(1.39-3.18)). Moreover, any HR-HPV type (PR 3.04; 95% CI 1.75-5.26), concurrent sexually transmitted infection (STI) (2.13; (1.28-3.55)) and HIV + /HPV + coinfection (1.75; (1.07-2.88)) remained independently associated with ASIL in the multivariate model. CONCLUSIONS Abnormal anal cytology among MSM and transgender is prevalent enough to consider optimal screening regimens. Further studies are required to see if periodic anal cytology can be made part of HIV care and treatment programs among MSM in Pakistan.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. .,Department of Community Health Sciences, Aga Khan University (AKU), Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Muhammad Mubarak
- Department of Cytology and Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | - Sören Andersson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
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4
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Aung ET, Fairley CK, Ong JJ, Bilardi JE, Chen MY, Chow EPF, Phillips TR. Exploring the attitudes of men who have sex with men on anal self-examination for early detection of primary anorectal syphilis: a qualitative study. BMC Infect Dis 2021; 21:982. [PMID: 34544383 PMCID: PMC8453991 DOI: 10.1186/s12879-021-06686-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies show men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, suggesting anorectal primary lesions are being missed. Regular anal self-examination might be able to detect anorectal syphilis lesions, hence potentially reducing transmission. This study aimed to explore the attitudes of MSM on performing anal self-examination to detect primary syphilis. METHODS In this qualitative study, 20 MSM over 18 years of age were purposively sampled from a sexual health clinic to participate in semi-structured interviews. Interviews were recorded, transcribed verbatim and data analysed thematically. RESULTS Four major themes and 12 sub-themes were generated from the study: (1) reasons for performing anal self-examination, (2) preferred educational resources for anal self-examination, (3) attitudes towards partner anal examination, and (4) acceptability of anal self-examination. Most participants had performed some form of anal self-examination in the past, and, just over half performed regularly for mostly health-related concerns. Most participants who infrequently or never performed anal self-examination were agreeable to perform regularly if it was recommended by health professionals with appropriate guidance. Participants preferred education on anal self-examination from health professionals and trusted online learning resources. CONCLUSION Our study showed MSM were agreeable to anal self-examination however would like to receive education and training to gain more confidence in conducting anal self-examination as a screening tool. Further studies are required to explore the adherence and acceptability of anal self-examination for syphilis prior to studies examining efficacy. The study provides foundation for any future policy aiming at utilising anal self-examination as a screening tool for syphilis among MSM.
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Affiliation(s)
- Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jade E Bilardi
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Turchan WT, Liauw SL. Chemoradiation for Anal Cancer: Clinical Outcomes and Strategies to Optimize the Therapeutic Ratio According to HPV Status. Semin Radiat Oncol 2021; 31:349-360. [PMID: 34455990 DOI: 10.1016/j.semradonc.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The incidence of anal cancer in the United States has increased in recent years, primarily related to the increasing incidence of HPV-associated anal squamous cell carcinoma, which is estimated to represent 80%-95% of anal cancers. Similar to head and neck cancer, HPV association has been demonstrated to be a strong positive prognostic factor in patients with anal cancer. Encouraging results from a number of studies investigating treatment de-escalation for HPV-associated oropharyngeal cancer support the notion that similar attempts may be feasible in HPV-associated anal cancer; however, the data to support this hypothesis are currently lacking. Studies are needed to determine how, if at all, HPV status should impact the management of patients with anal cancer. This review summarizes the relationship between HPV association and outcomes for patients with anal cancer, and how HPV status may impact the treatment of patients with anal cancer going forward.
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Affiliation(s)
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL.
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The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020826. [PMID: 33478019 PMCID: PMC7835774 DOI: 10.3390/ijerph18020826] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Abstract
This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality
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8
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Bien-Gund CH, Zhao P, Cao B, Tang W, Ong JJ, Baral SD, Bauermeister JA, Yang LG, Luo Z, Tucker JD. Providing competent, comprehensive and inclusive sexual health services for men who have sex with men in low- and middle-income countries: a scoping review. Sex Health 2020; 16:320-331. [PMID: 31213225 DOI: 10.1071/sh18191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
Although men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmissible infections, sexual health services for MSM in low- and middle-income countries (LMIC) remain under-resourced and are poorly understood. A scoping review of literature on MSM sexual health in LMIC was conducted in order to identify key clinical services and gaps in knowledge. Three databases were searched, in addition to hand-reviewing key journals and bulletins, to identify literature with a focus on MSM sexual health. Key services related to providing care to MSM in LMIC that emerged from our review are described. These services include creation of safe and confidential clinic environments, HIV testing services, behavioural interventions, HIV pre-exposure prophylaxis (PrEP), rapid antiretroviral therapy (ART) initiation and STI services. Compared with high-income settings, major differences in LMIC include lack of diagnostic technology, unfavourable legal environments and lack of funding for MSM health. Innovative approaches to healthcare delivery, such as harnessing mobile technology, self-testing and crowdsourcing interventions, can improve health services among MSM in LMIC. There are gaps in the evidence about how best to provide sexual health services for MSM in LMIC settings. Implementation research and scale-up of existing biomedical and behavioural interventions, such as HIV/STI testing services, PrEP and early antiretroviral initiation are urgently needed in LMIC.
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Affiliation(s)
- Cedric H Bien-Gund
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Peipei Zhao
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, 3688 Nanhai Avenue, Shenzhen 518060, China
| | - Weiming Tang
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC 27516, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, 418 Curie Boulevard, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Li-Gang Yang
- Guangdong Provincial STD Control Center, No. 2 Lujing Road, Guangzhou 510095, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Joseph D Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; and Institute of Global Health and Infectious Diseases, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599, USA; and Corresponding author.
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The importance of anal cancer screening and high-resolution anoscopy to gastroenterology practice. Curr Opin Gastroenterol 2020; 36:393-401. [PMID: 32701604 DOI: 10.1097/mog.0000000000000661] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Although human papillomavirus (HPV)-related anal squamous cell cancer (ASCC) is rare, its incidence has been rising and in high-risk populations exceeds the incidence of cancers for which screening programs are implemented. Therefore, targeted screening techniques are being evaluated with high-resolution anoscopy (HRA) as the current gold standard because of its ability to detect anal intraepithelial dysplasia (AIN) and premalignant high-grade squamous intraepithelial lesions (HSILs). However, a scarcity of trained providers presents a barrier to screening. RECENT FINDINGS ASCC incidence is rising especially in elderly women and young black men. Premalignant HSIL may not only progress to ASCC but also regress. Biomarkers such as HPV type, p16 immunostaining and DNA methylation markers may emerge as predictors of disease progression.HRA with acetic acid and Lugol's iodine staining can be used to detect HSIL and ASCC. Recent studies suggest that anal cancer screening may have an impact on the stage of ASCC at diagnosis and the incidence of anal cancer.The Anal Cancer HSIL Outcomes Research (ANCHOR) study is underway to determine whether treating HSIL effects ASCC incidence. SUMMARY Although there are no consensus screening guidelines for anal cancer, it is reasonable to screen high-risk populations with physical examination, anal cytology and HRA. Gastroenterologists can support anal cancer screening programmes through identifying patients at risk, performing noninvasive screening and considering to incorporate endoscopic techniques to examine the anal canal. VIDEO ABSTRACT: http://links.lww.com/COG/A32.
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Hicks JT, Hwang LY, Baraniuk S, White M, Chiao EY, Onwuka N, Ross MW, Nyitray AG. Factors associated with self-reported anal cancer screening history in men who have sex with men. Sex Health 2020; 16:96-98. [PMID: 30517839 DOI: 10.1071/sh18039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/31/2018] [Indexed: 11/23/2022]
Abstract
Background Men who have sex with men (MSM) are at greater risk of developing anal cancer caused by human papillomavirus (HPV) than the rest of the general population. Currently, there are no formal national guidelines in the US advising men how and when to get anal cancer screening. We sought to assess differences in demographics, familiarity and anxiety about anal cancer among men who report having had anal cancer screening (i.e. anal cytology and/or a digital anorectal examination (DARE)). METHODS MSM were recruited to participate in a study to assess the feasibility of teaching self and partner anal examinations as a means of screening for anal cancer. Data for this secondary analysis were obtained using a written pre-test and a computer-assisted self-interview. Factors associated with screening were assessed with multivariable logistic regression to allow calculation of adjusted odds ratios (aORs). RESULTS Of the 197 participants with data, 145 (73.6%) reported having had anal cancer screening (either anal cytology, DARE or both) during their lifetime. Men who were younger, Black and HIV-negative were associated with decreased odds of reporting any type of anal cancer screening. For example, compared with White men, Black men were 80% less likely to report screening (aOR 0.2; 95% confidence interval (CI) 0.1-0.5). Self-perception of anal cancer knowledge was not associated with screening in multivariable analysis (aOR 1.6; 95% CI 0.6-3.9). CONCLUSIONS Age, race and HIV status were independently associated with a history of anal cancer screening.
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Affiliation(s)
- Joseph T Hicks
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, 501 D.W. Brooks Drive, Athens, GA 30602, USA
| | - Lu-Yu Hwang
- Center for Infectious Diseases, Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health at Houston, 1200 Pressler Street, Houston, TX 77030, USA
| | - Sarah Baraniuk
- Coordinating Center for Clinical Trials, Department of Biostatistics, The University of Texas School of Public Health at Houston, 1200 Pressler Street, Houston, TX 77030, USA
| | - Margaret White
- Gordon E. Crofoot MD, PA, 3701 Kirby Drive, Suite 1230, Houston, TX 77098, USA
| | - Elizabeth Y Chiao
- Department of Internal Medicine, Baylor College of Medicine, 6620 Main Street, Houston, TX 77030, USA
| | - Nkechi Onwuka
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health at Houston, 1200 Pressler Street, Houston, TX 77030, USA
| | - Michael W Ross
- University of Minnesota, Program in Human Sexuality, 1300 South 2nd Street, Suite 180, Minneapolis, MN 55454, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Nyitray AG, D'Souza G, Stier EA, Clifford G, Chiao EY. The Utility of Digital Anal Rectal Examinations in a Public Health Screening Program for Anal Cancer. J Low Genit Tract Dis 2020; 24:192-196. [PMID: 31972661 PMCID: PMC7147422 DOI: 10.1097/lgt.0000000000000508] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES There are no uniform screening recommendations for anal cancer. Medical practice guidelines are now available on the use of Digital Anal Rectal Examinations (DARE) for the detection of anal cancer; however, because screening can result in more harm than benefit, our objective was to assess the evidence for use of DARE as a public health screening tool. MATERIALS AND METHODS We conducted a current critical appraisal of anal cancer literature using World Health Organization criteria for assessing the potential utility of a public health screening program. RESULTS Digital Anal Rectal Examination satisfies most, but not all, World Health Organization criteria for a public health program that seeks to detect early invasive anal cancer in populations at high risk for anal cancer, most notably HIV-positive men who have sex with men; however, DARE is not appropriate when facilities for treatment are nonexistent. In addition, there are insufficient data on DARE sensitivity and specificity. CONCLUSIONS The mildly invasive nature of DARE, limited likelihood of adverse procedure-related events, cost-effectiveness and patient acceptability, as well as wide availability of DARE support consideration of its integration into screening for populations at high risk of anal cancer, especially HIV-positive men who have sex with men.
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Affiliation(s)
- Alan G. Nyitray
- Clinical Cancer Center and Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth A. Stier
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA
| | - Gary Clifford
- International Agency for Research on Cancer, Lyon, France
| | - Elizabeth Y. Chiao
- Section Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
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Higa DH, Crepaz N, McDonald CM, Adegbite-Johnson A, DeLuca JB, Kamitani E, Sipe TA. HIV Prevention Research on Men Who Have Sex With Men: A Scoping Review of Systematic Reviews, 1988-2017. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:1-S7. [PMID: 32073309 DOI: 10.1521/aeap.2020.32.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the United States, men who have sex with men (MSM) are disproportionately affected by HIV. To identify research gaps and inform HIV prevention for MSM, we conducted a scoping review of systematic reviews using CDC's Prevention Research Synthesis database. Eligibility criteria comprised English-language systematic reviews focused on HIV prevention for MSM, published during 1988-2017, and included at least one U.S. primary study. We coded data type, subpopulations, topics, and key findings. To assess study quality, we used the Assessment of Multiple Systematic Reviews (AMSTAR). Among 129 relevant systematic reviews, study quality was high or moderate for 63%. Most common topics were sexual behavior and disease vulnerability. The most frequently mentioned MSM subgroups were HIV-positive, Black or African American, and young. Research gaps include Hispanic/Latino MSM, pre-exposure prophylaxis (PrEP), treatment as prevention, social determinants of health, health disparities, syndemics, and protective factors for sexual health.
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Affiliation(s)
- Darrel H Higa
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Nicole Crepaz
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Christina M McDonald
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | - Julia B DeLuca
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Emiko Kamitani
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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Koskan AM, Brennhofer SA, Helitzer DL. Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines: practitioners' perspectives. Cancer Causes Control 2019; 30:989-996. [PMID: 31302838 DOI: 10.1007/s10552-019-01209-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Immunocompromised populations including people living with HIV (PLWH) suffer disproportionate burden from anal cancer, a rare cancer caused by persistent infection of the anal canal with oncogenic strains of human papillomavirus. In the US, there are no nationally adopted screening guidelines for anal cancer. In the absence of such guidelines, this study explores healthcare practitioners' screening practices for early signs of anal cancer among PLWH. METHODS Between November 2017 and June 2018, the research team completed 25 interviews among a diverse sample of healthcare practitioners who provide care for PLWH. RESULTS Providers expressed frustration that screening and treatment guidelines for anal cancer were scant, and they varied in their screening practices. The majority of providers screened PLWH for anal dysplasia via the anal Pap smear; few providers were trained and had the medical equipment to conduct high-resolution anoscopy-guided biopsies, a more sensitive and specific screening method. Others screened through digital ano-rectal examinations (DARE) and both visually and with a DARE. Participants discussed how providers may be over-treating their patients who have high-grade anal intraepithelial neoplasia (AIN) and the role of biomarkers to determine whether the lesion is carcinogenic. CONCLUSIONS Practitioners who provide care for PLWH are proactive in screening to help prevent and control anal cancer, a rare and slow-growing disease. Continuing to regularly surveil high-risk populations, particularly PLWH previously diagnosed with high-grade lesions, is critical to prevent and control anal cancer.
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Affiliation(s)
- Alexis M Koskan
- College of Health Solutions, Arizona State University, 425 N. 5th Street, Phoenix, AZ, 85004, USA.
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14
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International Anal Neoplasia Society Guidelines for the Practice of Digital Anal Rectal Examination. J Low Genit Tract Dis 2019; 23:138-146. [DOI: 10.1097/lgt.0000000000000458] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Ong JJ, Walker S, Grulich A, Hoy J, Read TRH, Bradshaw C, Chen M, Garland SM, Hillman R, Templeton DJ, Hocking J, Eu B, Tee BK, Chow EPF, Fairley CK. Incorporating digital anorectal examinations for anal cancer screening into routine HIV care for men who have sex with men living with HIV: a prospective cohort study. J Int AIDS Soc 2018; 21:e25192. [PMID: 30516346 PMCID: PMC6280647 DOI: 10.1002/jia2.25192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) living with HIV have a high risk of anal cancer, which is often detected at late stages, when morbidity and mortality are high. The objective of this study was to describe the feasibility and challenges to incorporating regular digital anorectal examination (DARE) into routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service. METHODS In 2014, we recruited 327 MSM living with HIV, aged 35 and above from one major sexual health centre (n = 187), two high HIV caseload general practices (n = 118) and one tertiary hospital (n = 22) in Melbourne, Australia. Men were followed up for two years and DARE was recommended at baseline, year 1 and year 2. Data were collected regarding patient and physician experience, and health service use. An ordered logit model was used to assess the relationship between sociodemographic factors and the number of DAREs performed. RESULTS Mean age of men was 51 (SD ± 9) years, 69% were Australian born, 32% current smokers, and mean CD4 was 630 (SD ± 265) cells per mm3 , with no significant differences between clinical sites. Overall, 232 (71%) men received all three DAREs, 71 (22%) received two DAREs, and 24 (7%) had one DARE. Adverse outcomes were rarely reported: anal pain (1.2% of total DAREs), bleeding (0.8%) and not feeling in control of their body during the examination (1.6%). Of 862 DAREs performed, 33 (3.8%) examinations resulted in a referral to a colorectal surgeon. One Stage 1 anal cancer was detected. CONCLUSION Incorporation of an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.
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Affiliation(s)
- Jason J Ong
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- London School of Hygiene and Tropical MedicineLondonUK
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Sandra Walker
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jennifer Hoy
- Department of Infectious DiseasesAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia
| | - Tim RH Read
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Catriona Bradshaw
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Marcus Chen
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Suzanne M Garland
- Department of Obstetrics and GynaecologyDepartment of Microbiology in Infectious DiseasesUniversity of MelbourneRoyal Women's HospitalMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Richard Hillman
- HIV, Immunology and Infectious DiseaseSt Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - David J Templeton
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- RPA Sexual HealthSydney Local Health DistrictSydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Jane Hocking
- Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Beng Eu
- Prahran Market ClinicPrahranVictoriaAustralia
| | - Bian Kiem Tee
- The Centre ClinicVictorian AIDS CouncilSt KildaVictoriaAustralia
| | - Eric P F Chow
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Christopher K Fairley
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
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Abstract
BACKGROUND The risk of anal carcinoma after previous diagnosis of anal intraepithelial neoplasia III is unclear. OBJECTIVE The purpose of this study was to estimate the risk of anal carcinoma in patients with anal intraepithelial neoplasia III and to identify predictors for subsequent malignancy. DESIGN This was a retrospective review using the Surveillance, Epidemiology, and End Results registry (1973-2014). SETTING The study was composed of population-based cancer registries from the United States. PATIENTS Patients who were diagnosed with anal intraepithelial neoplasia III were included. MAIN OUTCOME MEASURES The primary outcome was rate of subsequent anal squamous cell carcinoma. Predictors for anal cancer were identified using logistic regression and Cox proportional hazard models. RESULTS A total of 2074 patients with anal intraepithelial neoplasia III were identified and followed for a median time of 4.0 years (interquartile range, 1.8-6.7 y). Of the cohort, 171 patients (8.2%) subsequently developed anal cancer. Median time from anal intraepithelial neoplasia III diagnosis to anal cancer diagnosis was 2.7 years (interquartile range, 1.1-4.5 y). Fifty-two patients (30.4%) who developed anal carcinoma were staged T2 or higher. Ablative therapies for initial anal intraepithelial neoplasia III were associated with a reduction in the risk of anal cancer (OR = 0.3 (95% CI, 0.1-0.7); p = 0.004). Time-to-event analysis revealed that the 5-year incidence of anal carcinoma after anal intraepithelial neoplasia III was 9.5% or ≈1.9% per year. LIMITATIONS The registry did not record HIV status, surveillance schedule, use of high-resolution anoscopy, or provider specialty. CONCLUSIONS In the largest published cohort of patients with anal intraepithelial neoplasia III, ≈10% of patients were projected to develop anal cancer within 5 years. Nearly one third of anal cancers were diagnosed at stage T2 or higher despite a previous diagnosis of anal intraepithelial neoplasia III. Ablative procedures were associated with a decreased risk of cancer. This study highlights the considerable rate of malignancy in patients with anal intraepithelial neoplasia III and the need for effective therapies and surveillance. See Video Abstract at http://links.lww.com/DCR/A764.
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Pernot S, Boucheron P, Péré H, Lucas ML, Veyer D, Fathallah N, de Parades V, Pavie J, Netter J, Collias L, Taieb J, Grabar S, Weiss L. Comparison of anal cancer screening strategies including standard anoscopy, anal cytology, and HPV genotyping in HIV-positive men who have sex with men. Br J Cancer 2018; 119:381-386. [PMID: 30026613 PMCID: PMC6068120 DOI: 10.1038/s41416-018-0176-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is no consensus on screening strategy of high-grade intraepithelial neoplasia (HGAIN). Guidelines range from clinical examination with digital anorectal examination followed by standard anoscopy (SA), to anal cytology (Pap)+/- HPV genotyping. We compared screening strategy yields based on Pap, SA, and HPV-16 genotyping alone or in combination in HIV-MSM. METHODS Pap, SA, and HPV-16 genotyping were performed in all HIV-MSM attending a first anal cancer screening consultation in Paris, France. High-resolution anoscopy, the gold standard to detect HGAIN, was performed in the case of HPV-16 positivity or abnormal cytology. Yield was defined as the number of patients with HGAIN relative to the total number of patients screened. RESULTS On 212 patients, the complete strategy (SA + Pap + HPV genotyping) yield (12.7%) was significantly higher than that of SA (3.3%, p < 0.001) and HPV-16 alone (6.6%, p < 0.05). Although none of the other strategies were significantly different from the complete strategy, Pap + HPV-16 and Pap + SA had closer yields (about 11%), with OR = 0.83 (95% CI [0.44;1.57]) and 0.87 (95% CI [0.46;1.64]), respectively. CONCLUSIONS Pap combined with HPV-16 genotyping or SA tended towards higher yields compared to Pap alone, and closer to that of the complete strategy.
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Affiliation(s)
- Simon Pernot
- Department of Hepato-Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, APHP, Paris, France.
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Pauline Boucheron
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu Hospital, APHP, Paris, France
| | - Hélène Péré
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Virology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Marie-Laure Lucas
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France
| | - David Veyer
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Virology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Nadia Fathallah
- Department of Proctology, Saint-Joseph Hospital, Paris, France
| | | | - Juliette Pavie
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Jeanne Netter
- Department of Hepato-Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Lio Collias
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Julien Taieb
- Department of Hepato-Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, APHP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sophie Grabar
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu Hospital, APHP, Paris, France
| | - Laurence Weiss
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France.
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Mboumba Bouassa RS, Mbeko Simaleko M, Camengo SP, Mossoro-Kpinde CD, Veyer D, Matta M, Robin L, Longo JDD, Grésenguet G, Péré H, Meye JF, Belec L. Unusual and unique distribution of anal high-risk human papillomavirus (HR-HPV) among men who have sex with men living in the Central African Republic. PLoS One 2018; 13:e0197845. [PMID: 29795661 PMCID: PMC5967740 DOI: 10.1371/journal.pone.0197845] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/27/2018] [Indexed: 12/05/2022] Open
Abstract
Background High-risk (HR) human papillomavirus (HPV) infection remains a great concern in relation to African men who have sex with men (MSM), especially those infected with HIV. The prevalence of HR-HPV and associated risk factors was estimated in a cross-sectional observational study covering MSM living in Bangui, Central African Republic. Methods MSM receiving care at the Centre National de Référence des Infections Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, were included. HIV serostatus and socio-demographic and behavioral characteristics were collected. HPV DNA was detected and genotyped on anal swabs using Anyplex™ II HPV28 test (Seegene, South Korea), and HSV DNA by in-house real-time PCR. Logistic regression analyses were used to determine risk factors associated with HPV outcomes. Results 42 MSM (mean age, 23.2 years; range, 14–39) including 69.1% HIV-1-positive and 30.9% HIV-negative were prospectively enrolled. The prevalence of anal HPV was 69.1%, including 82.7% of HR-HPV which were multiple in 52.0%. The most prevalent genotypes were HPV-35, HPV-58, HPV-59 and HPV-31. While, HPV-16 and HPV-18 were present in a minority of samples. Multiple HR-HPV infection was more frequent in HIV-positive MSM (41.4%) with 2.7 genotypes per anal samples than in HIV-negative (7.7%) with 1.5 genotypes per anal samples. HPV types included in the prophylactic Gardasil-9® vaccine were detected in 68.9% of specimens and HPV-58 was the most frequently detected. MSM infected by HPV-16 and HPV-18 were all infected by HIV-1. Few anal swabs (11.9%) contained HSV-2 DNA without relationship with HPV detection. Condomless receptive anal intercourse was the main risk factor to being infected with any type of HPV and condomless insertive anal intercourse was significantly less associated with HPV contamination than receptive anal intercourse (Odd ratio = 0.02). Conclusion MSM in Bangui are at-risk of HIV and HR-HPV anal infections. The unusual distribution of HPV-35 as predominant HPV suggests possible geographic specificities in the molecular epidemiology of HR-HPV in sub-Saharan Africa. Scaling up prevention strategies against HPV infection and related cancers adapted for MSM in Africa should be prioritized. Innovative interventions should be conceived for the MSM population living in Bangui.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale Régionale d’Infectiologie Tropicale de Franceville, Franceville, Gabon
- Ecole Doctorale Bio Sorbonne Paris Cité, BioSPC, Paris Descartes, Paris, France
| | - Marcel Mbeko Simaleko
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
| | - Serge Police Camengo
- Servivce de Gastro-entérologie, Hôpital de l’Amitié, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Christian Diamant Mossoro-Kpinde
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Laboratoire National de Biologie Clinique et de Santé Publique, Bangui, Central African Republic
- * E-mail:
| | - David Veyer
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mathieu Matta
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Leman Robin
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean De Dieu Longo
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Gérard Grésenguet
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Hélène Péré
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-François Meye
- Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire d’Angondjé, Libreville et Faculté de Médecine de Libreville, Université des Sciences de la Santé, Libreville, Gabon
| | - Laurent Belec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Robbins HA, Wiley DJ, Ho K, Plankey M, Reddy S, Joste N, Darragh TM, Breen EC, Young S, D'Souza G. Patterns of repeated anal cytology results among HIV-positive and HIV-negative men who have sex with men. PAPILLOMAVIRUS RESEARCH 2018; 5:143-149. [PMID: 29626643 PMCID: PMC5909063 DOI: 10.1016/j.pvr.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
Background Men who have sex with men (MSM) are at increased risk for anal cancer. In cervical cancer screening, patterns of repeated cytology results are used to identify low- and high-risk women, but little is known about these patterns for anal cytology among MSM. Methods We analyzed Multicenter AIDS Cohort Study (MACS) data for MSM who were offered anal cytology testing annually (HIV-positive) or every 2 years (HIV-negative) for 4 years. Results Following an initial negative (normal) cytology, the frequency of a second negative cytology was lower among HIV-positive MSM with CD4 ≥ 500 (74%) or CD4 < 500 (68%) than HIV-negative MSM (83%) (p < 0.001). After an initial abnormal cytology, the frequency of a second abnormal cytology was highest among HIV-positive MSM with CD4 < 500 (70%) compared to CD4 ≥ 500 (53%) or HIV-negative MSM (46%) (p = 0.003). Among HIV-positive MSM with at least three results, 37% had 3 consecutive negative results; 3 consecutive abnormal results were more frequent among CD4 < 500 (22%) than CD4 ≥ 500 (10%) (p = 0.008). Conclusions More than one-third of HIV-positive MSM have consistently negative anal cytology over three years. Following abnormal anal cytology, a repeated cytology is commonly negative in HIV-negative or immunocompetent HIV-positive men, while persistent cytological abnormality is more likely among HIV-positive men with CD4 < 500.
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Affiliation(s)
- Hilary A Robbins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E6132, Baltimore, MD 21205, USA
| | - Dorothy J Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Ken Ho
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Susheel Reddy
- Department of Infectious Disease, Northwestern University, Chicago, IL, USA
| | - Nancy Joste
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM and Tricore Reference Laboratories, Albuquerque, NM, USA
| | - Teresa M Darragh
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Stephen Young
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM and Tricore Reference Laboratories, Albuquerque, NM, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E6132, Baltimore, MD 21205, USA.
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Clutterbuck D, Asboe D, Barber T, Emerson C, Field N, Gibson S, Hughes G, Jones R, Murchie M, Nori AV, Rayment M, Sullivan A. 2016 United Kingdom national guideline on the sexual health care of men who have sex with men. Int J STD AIDS 2018:956462417746897. [PMID: 29334885 DOI: 10.1177/0956462417746897] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.
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Affiliation(s)
| | - David Asboe
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Tristan Barber
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Nigel Field
- 4 Public Health England, London, UK
- 5 University College London, London, UK
| | | | | | - Rachael Jones
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Achyuta V Nori
- 8 8945 Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - Michael Rayment
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Ann Sullivan
- 9 BASHH CEG, BASHH 2017 Registered Office, Macclesfield, UK
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Poljak M, Šterbenc A, Lunar MM. Prevention of human papillomavirus (HPV)-related tumors in people living with human immunodeficiency virus (HIV). Expert Rev Anti Infect Ther 2017; 15:987-999. [PMID: 29027811 DOI: 10.1080/14787210.2017.1392854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION In comparison to their HIV-negative counterparts, people living with HIV (PLWH) have a higher prevalence of human papillomavirus (HPV) infection in various anatomical sites coupled with increased HPV persistence, higher risk of HPV-related tumors, and faster disease progression. Areas covered: Gender-neutral prevention strategies for HPV-related cancers in PLWH discussed: ABC approach, HPV vaccination, antiretroviral treatment (ART), anal cancer screening, and smoking cessation. Gender specific strategies: cervical cancer screening reduces the incidence and mortality of cervical cancer and circumcision might reduce the risk of HPV infections in men. Expert commentary: HPV-related cancer incidence has not declined (e.g. cervical cancer) and has even increased (e.g. anal cancer) in the ART era, demanding an effective HPV prevention strategy. HPV vaccination should be introduced into national prevention programs worldwide immediately because current prophylactic vaccines are safe, tolerable, and immunogenic in PLWH. HPV vaccine efficacy trials in PLWH are essential to determine the most appropriate immunization schedule. The population most at risk of anal cancer is HIV-positive men who have sex with men, who are not protected by herd immunity if only the female population is vaccinated. Unvaccinated PLWH need enhanced surveillance for early detection of HPV-related cancers and their precursors.
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Affiliation(s)
- Mario Poljak
- a Institute of Microbiology and Immunology, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
| | - Anja Šterbenc
- a Institute of Microbiology and Immunology, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
| | - Maja M Lunar
- a Institute of Microbiology and Immunology, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
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Abstract
The number of women living with HIV continues to increase. Thirty years into the
AIDS epidemic, we now expect those with access to highly active antiretroviral
to survive into their seventh decade of life or beyond. Increasingly, the focus
of HIV care is evolving from preventing opportunistic infections and treating
AIDS-defining malignancies to strategies that promote longevity. This holistic
approach to care includes detection of malignancies that are associated with
certain viral infections, with chronic inflammation, and with lifestyle choices.
The decision to screen an HIV-infected women for cancer should include an
appreciation of the individualized risk of cancer, her life expectancy, and an
attempt to balance these concerns with the harms and benefits associated with
specific cancer screening tests and their potential outcome. Here, we review
cancer screening strategies for women living with HIV/AIDS with a focus on
cancers of the lung, breast, cervix, anus, and liver.
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Affiliation(s)
- David M Aboulafia
- 1 Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA.,2 Division of Hematology, University of Washington, Seattle, WA, USA
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van Amsterdam MA, van Assen S, Sprenger HG, Wilting KR, Stienstra Y, Bierman WFW. Yield of yearly routine physical examination in HIV-1 infected patients is limited: A retrospective cohort study in the Netherlands. PLoS One 2017. [PMID: 28636651 PMCID: PMC5479549 DOI: 10.1371/journal.pone.0179539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Routine physical examinations might be of value in HIV-infected patients, but the yield is unknown. We determined the diagnoses that would have been missed without performing annual routine physical examinations in HIV-infected patients with stable disease. Methods Data were collected from the medical records of 299 HIV-1-infected patients with CD4 count >350 cells/mm3 if not using combination antiretroviral therapy (cART), or CD4 count >100 cells/mm3 and undetectable viral load if using cART. We defined the diagnoses that would have been missed without performing routine physical examinations on annual check-ups in 2010. Exclusion criteria were hepatitis B/C co-infection, start/ switch of cART < 24 weeks, pregnancy, and transgenderism. Results 215 patients (72%) had positive findings: lipodystrophy (30%), lymphadenopathy (16%) and hypertension (8.4%) were the most common. Two-thirds of all findings were not new or were based on complaints indicating a physical examination even if not routinely scheduled. For 24 patients (8.0%) the routine physical examination led to the finding of a new diagnosis: six—all men who have sex with men (MSM)—had a concurrent sexually transmitted infection, eight had hypertension, and ten others had a large variety of diagnoses. A total atrioventricular block with bradycardia was the most clinically relevant finding. Conclusions Annual physical examinations of HIV-infected patients with stable disease brought few new diagnoses that would have been missed without performing a routine examination. Our results suggest that standard assessments could be restricted to six-monthly measuring blood pressure in all patients and annually performing anogenital and digital rectal examination on MSM.
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Affiliation(s)
- Marleen A. van Amsterdam
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sander van Assen
- Department of Internal Medicine, Treant Zorggroep, Emmen, the Netherlands
| | - Herman G. Sprenger
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kasper R. Wilting
- Department of Medical microbiology & Infection control, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ymkje Stienstra
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wouter F. W. Bierman
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
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Islami F, Ferlay J, Lortet-Tieulent J, Bray F, Jemal A. International trends in anal cancer incidence rates. Int J Epidemiol 2017; 46:924-938. [PMID: 27789668 DOI: 10.1093/ije/dyw276] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 12/19/2022] Open
Abstract
Background Previous studies have reported rapid increases in anal cancer incidence rates in seven high-income countries in North America, Europe and Oceania. There is very limited information on whether this pattern is replicated in other parts of the world. In this study, we examine recent trends in anal cancer incidence in 18 countries worldwide. Methods We calculated age-standardized incidence rates for anal squamous cell carcinoma (ASCC) and anal adenocarcinoma (AAC) for a minimum of 13 years through to 2007, using data from the International Agency for Research on Cancer's Cancer Incidence in Five Continents series, and applied joinpoint regression models to assess changes in incidence rates. We also conducted an extended analysis of the data from the USA through to 2012. Results ASCC was the main histological subtype in most of the countries considered in this analysis. The incidence of ASCC increased in both men and women in several high-income countries, including Australia, Canada, Denmark, France, Italy, Netherlands, the UK and the USA, whereas it increased only in women in Colombia, Estonia, the Russian Federation, Slovakia and Switzerland. Conversely, there was little change in the incidence of ASCC in either men or women in India, Israel, Japan, Singapore and Spain. The incidence rates of AAC decreased or were stable in most populations. Conclusions The ASCC incidence rates increased in both men and women or in women in all countries included in this study, except Asian countries and Spain, where the rates remained unchanged. Population-based preventive measures, including human papillomavirus vaccination and advocacy for safe sexual behaviours, may contribute to curbing the surging burden of the disease.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
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Wentzensen N, Arbyn M, Berkhof J, Bower M, Canfell K, Einstein M, Farley C, Monsonego J, Franceschi S. Eurogin 2016 Roadmap: how HPV knowledge is changing screening practice. Int J Cancer 2017; 140:2192-2200. [PMID: 28006858 DOI: 10.1002/ijc.30579] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 01/01/2023]
Abstract
Human papillomaviruses (HPVs) are the necessary cause of most cervical cancers, a large proportion of other anogenital cancers, and a subset of oropharyngeal cancers. The knowledge about HPV has led to development of novel HPV-based prevention strategies with important impact on clinical and public health practice. Two complementary reviews have been prepared following the 2015 Eurogin Conference to evaluate how knowledge about HPV is changing practice in HPV infection and disease control through vaccination and screening. This review focuses on screening for cervical and anal cancers in increasingly vaccinated populations. The introduction of HPV vaccines a decade ago has led to reductions in HPV infections and early cancer precursors in countries with wide vaccination coverage. Despite the high efficacy of HPV vaccines, cervical cancer screening will remain important for many decades. Many healthcare systems are considering switching to primary HPV screening, which has higher sensitivity for cervical precancers and allows extending screening intervals. We describe different approaches to implementing HPV-based screening efforts in different healthcare systems with a focus in high-income countries. While the population prevalence for other anogenital cancers is too low for population-based screening, anal cancer incidence is very high in HIV-infected men who have sex with men, warranting consideration of early detection approaches. We summarize the current evidence on HPV-based prevention of anal cancers and highlight important evidence gaps.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology & Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Johannes Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Bower
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Einstein
- Department of OB/GYN & Women's Health, Rutgers New Jersey Medical School, Newark, USA
| | - Christopher Farley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Human Papillomavirus Positivity in the Anal Canal in HIV-Infected and HIV-Uninfected Men Who Have Anal Sex with Men in Guangzhou, China: Implication for Anal Exams and Early Vaccination. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2641259. [PMID: 28133605 PMCID: PMC5241445 DOI: 10.1155/2017/2641259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/29/2016] [Indexed: 12/31/2022]
Abstract
Background. The epidemiology of HPV in men who have sex with men (MSM) in Guangzhou, China, had not been reported previously. Methods. HIV-infected and HIV-uninfected MSM were recruited from a Guangzhou-based MSM clinic in 2013. Sociodemographic characteristics and sexual behaviors were collected. An anal cytological sample was taken for HPV testing. Results. We recruited 79 HIV-infected and 85 HIV-uninfected MSM. The median age was 26 years in both groups. The positivities of anal HPV of any type (81.0% versus 48.2%), any high risk type (50.6% versus 27.1%), any low risk type (55.7% versus 31.8%), and any 9-valent vaccine type (74.7% versus 36.5%) were all significantly higher among HIV-infected compared to that among HIV-negative MSM (p for all < 0.05). The great majority of HPV-infected MSM were infected with 9-valent vaccine types (59 out of 64 HIV-infected and 31 out of 41 HIV-uninfected). Anal bacterial infections were associated with higher anal HPV positivity and greater number of anal HPV types. Conclusion. Sexually active MSM in Guangzhou, especially those infected with HIV, had high and multiple HPV detections. The majority of these cases were potentially preventable by HPV vaccine. Regular anal exams and early HPV vaccination are warranted in this population.
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Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV. J Int AIDS Soc 2016; 19:20514. [PMID: 26942721 PMCID: PMC4778406 DOI: 10.7448/ias.19.1.20514] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/10/2016] [Accepted: 01/28/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Anal cancer in men who have sex with men (MSM) living with HIV is an important issue but there are no consistent guidelines for how to screen for this cancer. In settings where screening with anal cytology is unavailable, regular anal examinations have been proposed in some guidelines but their cost-effectiveness is unknown. Methods Our objective was to estimate the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive MSM living in Australia using a probabilistic Markov model. Data sources were based on the medical literature and a clinical trial of HIV-positive MSM receiving an annual anal examination in Australia. The main outcome measures for calculating effectiveness were undiscounted and discounted (at 3%) lifetime costs, life years gained, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratio (ICER). Results Base-case analysis estimated the average cost of screening for and management of anal cancer ranged from $195 for no screening to $1,915 for lifetime annual screening of men aged ≥ 50. Screening of men aged ≥ 50 generated ICERs of $29,760 per QALY gained (for screening every four years), $32,222 (every three years) and $45,484 (every two years). Uncertainty for ICERs was mostly influenced by the cost (financially and decrease in quality of life) from a false-positive result, progression rate of anal cancer, specificity of the anal examination, the probability of detection outside a screening program and the discount rate. Conclusions Screening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged ≥ 50 is most likely to be cost-effective by conventional standards. Given that anal pap smears are not widely available yet in many clinical settings, regular anal exams for MSM living with HIV to detect anal cancer earlier should be implemented.
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Gulvin J, Aboulafia DM. Squamous Cell Cancer of Unknown Primary and Primary Breast Cancer in an HIV-Infected Woman: The Importance of Cancer Screening for People Living with HIV/AIDS. J Int Assoc Provid AIDS Care 2016; 15:194-200. [PMID: 26864079 DOI: 10.1177/2325957416629550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
People living with HIV/AIDS (PLWHA) are surviving longer, with an increased risk of cancer. Cancer screening strategies in PLWHA are lacking. We describe the case of a woman with a history of AIDS, who had a nondetectable viral load on treatment. She is an activist, promoting HIV care, but had not undergone routine screening for breast, cervical, or colonic neoplasia. She presented with a left groin mass, which on biopsy proved to be a p16 immuno-histochemical positive squamous cell carcinoma. Anal and cervicovaginal examinations did not show invasive cancer, although high-resolution anoscopy identified high-grade anal dysplasia. A mammogram followed by magnetic resonance imaging showed invasive ductal carcinoma. Her breast cancer was treated with lumpectomy, adjuvant brachytherapy and chemotherapy. The left groin tumor was treated with chemo-radiation. Herein, we also review medical literature concerning anal, cervical, breast, colorectal, and lung cancer screening for PLWHA, which is important for our aging population of PLWHA.
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Affiliation(s)
- Joshua Gulvin
- Division of General Internal Medicine, Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Section of Hematology and Oncology, Virginia Mason Medical Center, Seattle, WA, USA Division of Hematology, University of Washington, Seattle, WA, USA
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Leeds IL, Fang SH. Anal cancer and intraepithelial neoplasia screening: A review. World J Gastrointest Surg 2016; 8:41-51. [PMID: 26843912 PMCID: PMC4724586 DOI: 10.4240/wjgs.v8.i1.41] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/02/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations.
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Ong JJ, Grulich A, Walker S, Hoy J, Read T, Bradshaw C, Garland SM, Hillman R, Templeton D, Hocking J, Eu B, Tee BK, Fairley CK. Baseline findings from the Anal Cancer Examination (ACE) study: screening using digital ano-rectal examination in HIV-positive men who have sex with men. J Med Screen 2015; 23:70-6. [PMID: 26462726 DOI: 10.1177/0969141315604658] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/10/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cytological screening for anal cancer precursors is not always possible. We investigated digital ano-rectal examination (DARE) as a means of early anal cancer detection in HIV-positive men who have sex with men (MSM). METHODS We recruited 327 HIV-positive MSM aged 35 and over from clinics with HIV physicians in Melbourne, Australia, to receive an annual DARE. We analyzed baseline data from patient questionnaires regarding general, anal and sexual health, adverse effects from the anal examination, cancer worry, and quality of life. RESULTS The majority of men (82%, 95% CI:78-87) felt relaxed during the DARE, 1% (95% CI:0-3) complained of pain, and 1% (95% CI:0-4) reported bleeding after the examination. Nearly all men (99%, 95% CI:96-100) were willing to continue with an annual DARE. Quality of life was unaffected with utility scores of 0.76 before examination vs. 0.77 two weeks after examination, (p = 0.41). An anal abnormality was detected in 86 men (27%, 95% CI:22-31), with one anal cancer identified. The specialist referral rate following DARE was 5% (95% CI:3-8). Recruitment rates were significantly associated with the clinic setting (sexual health centre 78%, general practice 13%, hospital 14%, p = 0.002) and specialty (sexual health physician 67%, general practitioner 20%, infectious disease physician 14%, p = 0.031). CONCLUSION Annual DARE to detect anal cancer in HIV-positive MSM was acceptable for patients, with minimal side effects. Strategies to increase HIV physician's patient recruitment would be needed if DARE were to be implemented in anal cancer screening.
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Affiliation(s)
- Jason J Ong
- Melbourne School of Population and Global Health, University of Melbourne, Australia Melbourne Sexual Health Centre, Alfred Health, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Australia
| | - Tim Read
- Melbourne Sexual Health Centre, Alfred Health, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Australia Central Clinical School, Monash University, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia
| | | | | | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Beng Eu
- Prahran Market Clinic, Melbourne Australia
| | - B K Tee
- The Centre Clinic, Victorian AIDS Council, Melbourne Australia
| | - Christopher K Fairley
- Melbourne School of Population and Global Health, University of Melbourne, Australia Melbourne Sexual Health Centre, Alfred Health, Australia Central Clinical School, Monash University, Australia
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Raptis D, Schneider I, Matzel KE, Ott O, Fietkau R, Hohenberger W. The differential diagnosis and interdisciplinary treatment of anal carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:243-9. [PMID: 25891807 DOI: 10.3238/arztebl.2015.0243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anal carcinoma accounts for 2-4% of all cases of colorectal and anorectal carcinoma. Its peak incidence is from age 58 to age 64; women are affected somewhat more commonly than men. Its incidence has risen markedly in the past three decades. METHODS This article is based on a selective review of the literature, including the guidelines of the National Comprehensive Cancer Network and the European Society of Medical Oncology. RESULTS Anal carcinoma is often an incidental finding. About 85% of newly diagnosed cases are associated with an HPV infection with strain 16, 18, or 33. Radiochemotherapy with 5-fluorouracil and mitomycin C is the treatment of choice. The 5-year survival rate is 80-90%. Primary surgery with curative intent is indicated only for well-differentiated carcinoma of the anal margin (T1, N0). 10-30% of patients now undergo radical resection. The utility of endosonography and positron emission tomography for staging is debated and needs further study. CONCLUSION The treatment of patients with anal carcinoma requires a specialized multidisciplinary approach in accordance with the current evidence-based guidelines. The potential role of prophylactic vaccination against oncogenic types of HPV in the prevention of anal carcinoma merits further investigation.
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Affiliation(s)
- Dimitrios Raptis
- Department of Surgery, Universitätsklinikum Erlangen, Department of Radiation Oncology, Universitätsklinikum Erlangen
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Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia. J Int AIDS Soc 2015; 18:19895. [PMID: 25828269 PMCID: PMC4380906 DOI: 10.7448/ias.18.1.19895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/18/2015] [Accepted: 03/04/2015] [Indexed: 01/07/2023] Open
Abstract
Introduction The incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. We aimed to assess their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies targeting this group. Methods A cross-sectional study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings (a sexual health centre, tertiary hospital HIV outpatients and high HIV caseload general practices) completed a written questionnaire in 2013/14. Poor knowledge was defined as those who had never heard of anal cancer, or scored 5 or less out of 10 in knowledge questions amongst those who reported ever hearing about anal cancer. Underestimation of risk was defined as considering themselves as having the same or lower risk for anal cancer compared to the general population. Results Of 72% (95% confidence interval (CI): 67–77) who had heard of anal cancer, 47% (95% CI: 41–53) could not identify any risk factors for anal cancer. Of total men surveyed, 51% (95% CI: 46–57) underestimated their risk for anal cancer. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age), 95% CI: 1.01–1.07), had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21–3.51), and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18–4.93). They were less likely to consult a physician if they had an anal abnormality (OR 0.54, 95% CI: 0.31–0.96), to have had receptive anal sex (OR 0.12, 95% CI: 0.02–0.59) or speak English at home (OR 0.28, 95% CI: 0.09–0.90). Conclusions This survey of MSM living with HIV demonstrated limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are urgently needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.
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Ong JJ, Temple-Smith M, Chen M, Walker S, Grulich A, Hoy J, Fairley CK. Why are we not screening for anal cancer routinely - HIV physicians' perspectives on anal cancer and its screening in HIV-positive men who have sex with men: a qualitative study. BMC Public Health 2015; 15:67. [PMID: 25636181 PMCID: PMC4314790 DOI: 10.1186/s12889-015-1430-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background Anal cancer is a priority health issue in HIV positive men who have sex with men. Anal cancer screening may be aimed at either detecting the precursor lesion (high grade anal intraepithelial neoplasia(HGAIN)) or early anal cancer. To date no qualitative study has explored the views of HIV physicians regarding anal cancer and its screening. Methods We conducted indepth interviews with 20 HIV physicians (Infectious diseases, Immunology, Sexual health, General practice) in different settings (hospital, sexual health centres, general practice) from around Australia. Framework analysis was used to identify themes. Results HIV physicians viewed anal cancer as a significant health issue and all agreed on the importance of anal cancer screening amongst HIV positive MSM if a valid screening method was available. Barriers for utilizing anal cytology was based primarily on the theme of insufficient evidence (e.g. no studies demonstrating reduction in mortality following screening or effective treatments for HGAIN). Barriers for utilizing DARE for early cancer detection were based on systemic factors (e.g. lack of opportunity, lack of priority, differences in HIV care practices); health provider factors (lack of evidence, difficulty discussing with patients, lack of confidence in DARE) and patient factors (perceived discomfort of DARE for patients, low anal cancer risk awareness). Physicians were willing to consider the idea of patient self-examination and partner-examination although concerns were raised regarding its reliability and issues surrounding partner dynamics. Conclusions HIV physicians remain ambivalent regarding the most effective means to screen for anal cancer. More research is needed to address the physicians’ concerns before anal cancer screening can be implemented into routine HIV care.
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Affiliation(s)
- Jason J Ong
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3010, Australia.
| | - Meredith Temple-Smith
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Marcus Chen
- Melbourne Sexual Health Centre, Carlton, VIC, 3053, Australia. .,Central Clinical School, Monash University, Clayton, VIC, 3168, Australia.
| | - Sandra Walker
- Melbourne Sexual Health Centre, Carlton, VIC, 3053, Australia.
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Darlinghurst, NSW, 2010, Australia.
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Health and Monash University, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Carlton, VIC, 3053, Australia. .,Central Clinical School, Monash University, Clayton, VIC, 3168, Australia.
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