Five-Year Evaluation of an Anal Cancer Screening Program in Men Who Have Sex With Men With HIV at 2 Academic Center Clinics

被引:1
作者
Achhra, Amit C. [1 ]
Chan, Elizabeth [1 ]
Applebaum, Serina [1 ]
Guerrero, Maggie [2 ]
Hao, Ritche [1 ]
Pantel, Haddon [2 ]
Virata, Michael [1 ]
Fikrig, Margaret [1 ]
Barakat, Lydia [1 ]
机构
[1] Yale Sch Med, Dept Med, Sect Infect Dis, New Haven, CT USA
[2] Yale Sch Med, Dept Surg, Colon & Rectal Surg, New Haven, CT USA
关键词
anal cancer; human papillomavirus viruses; HIV; AIDS; cancer screening; SQUAMOUS INTRAEPITHELIAL LESIONS;
D O I
10.1093/cid/ciae541
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Guidelines recommend annual anal cytology-based squamous cell carcinoma of anus (SCCA) screening for men who have sex with men (MSM) with HIV aged >= 35 years (eligible population). Recommended threshold for high resolution anoscopy (HRA) depends on its availability: low-threshold (any abnormal cytology) if availability is high, and high-threshold (High-Grade Squamous Intraepithelial Lesion (HSIL) on cytology) if availability is low. Methods: Retrospective chart review (2018-2022) at academic HIV clinics. We evaluate (i) 5-year uptake of cytology based SCCA screening in eligible population; (ii) estimate HSIL detection rate based on our current low-threshold criteria, and if high-threshold criteria were used for HRA referral. Results: Of 432 eligible individuals, only 219 (50.7%) had at least one, and only 113 (26%) had >1 SCCA screening tests in a median followup of 4 years. N=74 (17.1%) of individuals had at least one abnormal anal cytology during follow-up, of which 56 (75.6%) received HRA. Increasing age (>= 57 years) and history of smoking negatively correlated with ever receiving screening. Anal cytology (365 tests in 206 individuals) showed: 17.5% 'unsatisfactory', and 26.8% with any abnormal cytology (zero with HSIL) triggering HRA referral. Only 34 individuals (7.8% of screening eligible) were ever detected with HSIL. Strictly using high-threshold criterion for HRA referral would have led to no HRA or HSIL detection. Conclusions: We noted poor uptake of screening over time, particularly in older age groups. Importantly, anal cytology performed poorly as a triage test for HRA referral: high rates of 'unsatisfactory' samples and low sensitivity for detecting HSIL.
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