Recent Guidelines on Anal Cancer Screening: A Systematic Review.

OBJECTIVES

Reports have recently been published on the risk stratification of anal squamous cell carcinoma (SCC) in several populations and the benefits of treating precancerous anal lesions to reduce the risk of progression to anal SCC. These studies have led several societies to publish new recommendations for anal cancer screening. This study systematically reviews anal cancer screening recommendations across different societies and institutes published after the ANCHOR trial.

METHODS

The authors systematically reviewed society recommendations for anal cancer screening that have been published since July 2022.

RESULTS

This study included 6 publications: 3 societies made recommendations only for individuals living with HIV, and 3 made recommendations for other high-risk groups, such as women with vulvar cancer/high-grade squamous intraepithelial lesions (HSILs) and female transplant recipients. Four societies recommended anal cytology, with or without human papillomavirus (HPV) testing, as the first screening method. One society recommended anal cytology, HPV testing, or cotesting as possible options, while 1 suggested HPV type 16 testing. Only 1 society has made recommendations on screening discontinuation. High-resolution anoscopy was recommended during follow-ups for individuals with abnormal results, although the referral threshold varied between societies according to the screening method results. All societies that mentioned anal HSIL treatment recommended it. Four societies expanded their recommendations beyond screening and treatment to include smoking cessation and/or HPV vaccination.

CONCLUSIONS

Currently, there are several recommendations for anal cancer screening that include target groups, screening methods, treatment, follow-up, and other anal SCC prevention methods.