Anal cancer screening in HIV-infected patients: is it time to screen them all?
Dis Colon Rectum
; 55(12): 1244-50, 2012 Dec.
Article
em En
| MEDLINE
| ID: mdl-23135582
ABSTRACT
BACKGROUND:
Annual screening for anal cancer is recommended only for HIV patients at increased risk men who have sex with men, individuals with a history of anogenital warts, and women with cervical dysplasia.OBJECTIVE:
The aim of this study was to examine the screening outcomes between HIV populations with and without these risk factors.METHODS:
We reviewed the records of all HIV patients referred for anal cytology and high-resolution anoscopy from June 2009 to June 2010. Patients were stratified into an increased-risk group or a standard-risk group. MAINOUTCOME:
Of the 329 evaluable patients, 285 (89.8% men, 10.2% women, mean age 46 ± 10 years) were classified to the increased-risk group, whereas 44 (72.7% men, 27.3% women, mean age 52 ± 8 years) were included in the standard-risk group. Male sex, white race, sexual orientation, past and current receptive anal intercourse, noncompliance with condom use, and absence of a new sexual partner were significantly different in the increased-risk group in comparison with the standard-risk group. In the increased-risk group, 187 (66.5%) patients had biopsy-proven dysplasia of which 118 (42.0%) had high-grade disease. In the standard-risk group, 15 (34.9%) patients had biopsy-proven dysplasia of which 7 (16.3%) had high-grade disease. Cytology detected biopsy-confirmed high-grade dysplasia only in 23 of 118 (19.5%) patients in the increased-risk group and in 2 of 7 (28.6%) patients in the standard-risk group. Kappa agreement in detecting high-grade disease was low for both increased-risk and standard-risk groups 0.16 (95% CI 0.07-0.23) and 0.40 (95% CI 0.02-0.40).LIMITATIONS:
Our study is a chart-based retrospective review of data with a small female population. Histology reports came from 2 different laboratories.CONCLUSION:
High-grade anal dysplasia was prevalent even among HIV patients who only have standard risk factors. Anal cytology and high-resolution anoscopy have poor agreement. We suggest considering annual screening by using high-resolution anoscopy in addition to cytology for all HIV patients regardless of risk factors.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias do Ânus
/
Infecções por HIV
/
Programas de Rastreamento
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Dis Colon Rectum
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Estados Unidos