Who should be screened for anal cancer?
The International Anal Neoplasia Society (IANS) recently released a set of guidelines for clinicians to follow when considering the possibility of offering screening for anal cancer. The guidelines recommend offering screening to patients who are at elevated risk for anal cancer, which the authors define as ten times the risk of the population at large.
However, clinicians who are considering screening many asymptomatic patients should take into account the availability of resources to provide adequate follow-up for abnormal results. In Canada, there is very limited access to high-resolution anoscopy (HRA, otherwise known as anal microscopy or colposcopy) for the definitive investigation and management of abnormal anal pap tests – only a few centres exist (in Vancouver, Toronto, Ottawa, and Montreal) and are generally limited in terms of how many patients can be seen. As such, patients with lower-risk abnormalities (such as ASC-US or LSIL) may not be able to access HRA and may have to live with the uncertainty of having “slightly abnormal” results.
IANS recommends the following actions to manage abnormal anal cytology results. In Canada, given limited access to HRA, we recommend following the management advice for “low HRA capacity”:
