Anal dysplasia in adolescent and young adult men who have sex with men: a single-center retrospective and descriptive study (2010-2020).

Objective: There are limited studies evaluating anal cytology results or the prevalence of anal human papiloma virus in adolescent and young adult (AYA) men who have sex with men (MSM). The purpose of this study was to review anal cytology screening results and determine whether abnormal findings resulted in completion of anoscopy in AYA MSM (13-26 years old). Patients and Methods: This was a retrospective study evaluating 84 anal Papanicolaou screening results among 36 AYA MSM patients aged 13-26 years who had an anal Papanicolaou test completed at an outpatient Adolescent/Young Adult Medicine Practice at Boston Children's Hospital, an urban, nonprofit, academic, free-standing children's hospital, from January 1, 2010, to December 31, 2020. Results: The findings of anal Papanicolaou screening included atypical squamous cells of undetermined significance (ASCUS) (37%), negative for squamous intraepithelial lesion (31%), inability to read (21.3%), and low-grade squamous intraepithelial lesion (10.8%). Most patients who had ASCUS results were referred for anoscopy (n = 28, 90.3%), and of those referred only 6.5% (n = 2) completed an anoscopy. Of those with low-grade squamous cell intraepithelial lesion results, 88.9% (n = 8) were referred for anoscopy, and among those who were referred, only 3.3% (n = 3) had completed an anoscopy. Conclusion: This study showed that there were abnormalities in cytology when anal Papanicolaou test screening was performed in this population, and the completion rates for anoscopy were low.

Anal dysplasia among solid organ transplant recipients; a cross sectional study / Displasia anal entre receptores de transplantes de órgãos sólidos - um estudo transversal

ABSTRACT Introduction: The incidence of anal cancer in United States has increased over of the last few decades impacting immunosuppressed populations like solid organ transplant recipients, in particular. The aim of this study was to evaluate the prevalence of anal dysplasia among solid organ transplant patients. We also attempted to identify factors that predispose solid organ transplant recipients to developing anal dysplasia. Methods and materials: Patients presenting to transplant office for routine care were recruited to participate in the study. All anal cytology specimens were collected using standard anal pap technique. The results were assessed using Bethesda classification. Information on perceived risk factors for development of anal dysplasia among our subjects was obtained. Results: Among 80 patients approached, 47 agreed to participate in the study. Of all the samples 19.1% had an inadequate amount of specimen to perform any analysis. Dysplastic cells were found in 10.5% of the specimens available for analysis. We were not able to identify any risk factors including age, gender distribution, smoking, and duration of immunosuppression that were statistically significant different between patients with anal dysplasia versus those without anal dysplasia. Conclusions: The rate of anal dysplasia detectable on cytology is high enough to warrant anal dysplasia screening in transplant recipients, which can then be followed up with high-resolution anoscopy with biopsy. Defining a cohort of patients among solid organ transplant recipients who are at an increased risk for the development of anal dysplasia mandating screening continues to be a challenge.

RESUMO Introdução: A incidência de câncer anal nos Estados Unidos aumentou nas últimas décadas, afetando populações imunossuprimidas, especialmente receptores de órgãos sólidos. O objetivo deste estudo foi avaliar a prevalência de displasia anal entre pacientes que receberam transplante de órgãos sólidos. Os autores buscaram identificar fatores que predispõem os receptores de transplante de órgãos sólidos a desenvolverem displasia anal. Métodos e materiais: Pacientes que se apresentaram ao consultório de transplante para acompanhamento de rotina foram recrutados para participar do estudo. Todos os espécimes de citologia foram coletados usando a técnica padrão de Papanicolau anal. Os resultados foram avaliados usando a classificação de Bethesda. Foram coletados dados sobre os fatores de risco percebidos para o desenvolvimento de displasia anal entre os participantes. Resultados: Dos 80 pacientes abordados, 47 concordaram em participar do estudo. Do total de amostras, 19,1% tinham uma quantidade inadequada para realizar qualquer análise. Células displásicas foram encontradas em 10,5% dos espécimes disponíveis para análise. Não foi possível identificar quaisquer fatores de risco, incluindo idade, distribuição de gênero, tabagismo e duração da imunossupressão, que foram estatisticamente diferentes entre pacientes com displasia anal e aqueles sem displasia anal. Conclusões: A taxa de displasia anal detectável na citologia é alta o suficiente para justificar a triagem em receptores de transplante, que pode então ser acompanhada com anuscopia de alta resolução com biópsia. A definição de triagem para uma coorte de pacientes entre os receptores de transplantes de órgãos sólidos que apresentam risco aumentado para o desenvolvimento displasia anal continua a ser um desafio.

The Effect of Anal Dysplasia and Cancer Screening Education on Attitudes, Beliefs, and Self-Efficacy.

Introduction: The incidence of anal cancer among individuals who are HIV-positive is estimated to be 80-fold higher than the general population. Implementation of anal dysplasia and cancer screening programs has been successful in urban HIV clinics. Lack of provider training is a primary barrier to such programs. The most effective method of increasing cancer screening among providers is interactive professional education. Methods: HIV care providers from a large medical institution in Chicago completed baseline surveys about knowledge, attitudes, beliefs, and measures of self-efficacy. They then participated in an interactive presentation. The survey was readministered following the presentation. Results: We had 100% survey completion by the 11 providers who participated. Significant differences were found in total scores (p < .01), perceived norms (p = .02), perceived behavioral control (p = .01), and intent to screen (p = .01). Discussion: Our findings suggest that HIV care providers respond well to education about screening practices. Most important, they left the sessions with increased intention to incorporate anal dysplasia and cancer screening in their clinical settings. Our recommendation is to incorporate interactive provider education into clinical practice.