Anal Cancer in High-Risk Women: The Lost Tribe

Simple Summary Anal cancer rates are on the rise, especially for women. Women with a background of genital dysplasia or cancer have been shown to be at a higher risk of anal cancer than the general population. Despite this, very little has been done to educate women of the increased risk and as a result women tend to present later with advanced disease. As anal cancer has a known precancerous precursor, there is potential for patients to receive preventative treatment prior to anal cancer development. Although, due to the rarity of the disease, there are currently no clinical guidelines for the prevention of anal cancer in women. There are likely to be missed opportunities in preventing anal cancer progression from treatable dysplastic precursor lesions. This review presents the current evidence supporting the screening, treatment, and surveillance of anal precancerous lesions in women with genital dysplasia or cancer. In developed countries the incidence of anal squamous cell carcinoma (SCC) has been rising; especially in women over the age of 60 years who present with more advanced disease stage than men. Historically, anal SCC screening has focused on people living with Human Immunodeficiency Virus (HIV) (PLWH) who are considered to be at the highest risk of anal SCC, and its precancerous lesion, anal squamous intraepithelial lesion (SIL). Despite this, women with vulval high-grade squamous epithelial lesions (HSIL) and SCCs have been shown to be as affected by anal HSIL and SCC as some PLWH. Nevertheless, there are no guidelines for the management of anal HSIL in this patient group. The ANCHOR trial demonstrated that treating anal HSIL significantly reduces the risk of anal SCC in PLWH, there is therefore an unmet requirement to clarify whether the screening and treatment of HSIL in women with a prior genital HSIL is also beneficial. This review presents the current evidence supporting the screening, treatment, and surveillance of anal HSIL in high-risk women with a previous history of genital HSIL and/or SCC.