Screening of human papilloma virus-related anogenital cancers in immunocompromised women: a systematic review of clinical practice guidelines.

OBJECTIVE

Human papillomavirus-related anogenital cancers disproportionately affect immunocompromised patients due to poor clearance rates and accelerated oncogenicity. This systematic review compares anogenital cancer screening Clinical Practice Guidelines among different subpopulations of immunocompromised women.

METHODS

We conducted a systematic review of guidelines addressing cervical, anal, vaginal, and vulvar cancer screening among immunocompromised women published between 2004 and 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Recommendations were categorized for women with human immunodeficiency virus, transplant recipients, and those with autoimmune conditions.

RESULTS

The final review included 26 guidelines. Guidelines for transplant recipients and women with autoimmune conditions were of poorer quality. Only 7 high-quality guidelines addressed resource-limited settings. There was no consensus on cervical cancer screening recommendations regarding initiation, cessation, frequency, methods, and colposcopy referral. Newer guidelines increasingly recommended triennial human papillomavirus testing or co-testing. For anal screening, most guidelines recommended annual cytology starting at age 45 if there is access to high-resolution anoscopy. Otherwise, digital anal rectal examination was recommended. One guideline addressed vaginal cancer screening in post-hysterectomy women with human immunodeficiency virus. It recommended annual vaginal cuff Pap testing and vaginal colposcopy for abnormal cytology or concomitant vulvar lesions. Routine vulvar cancer screening was not recommended.

CONCLUSIONS

More high-quality guidelines are required for immunocompromised women. Recommendations tailored to low- and lower-middle-income countries are urgently needed. Future guidelines should address the expansion of novel biologics, increased survival among various immunocompromised patient groups (eg, those with end-stage renal disease), and the need for differential screening algorithms according to levels of immunosuppression.