SA103 - Screening for Anal Cancer - Are We Leaving Women Behind?

Saturday, June 1, 2024

1:37 PM – 1:43 PM ET, USA

Location: Room 314-317

Abstract Podium Presenter(s)

YouJin Cho, PhD (she/her/hers)

Medical Student
The Ohio State University College of Medicine
The Ohio State University
Columbus, OH, United States

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Author(s)

Samantha Toscano, BS

Medical Student
Ohio State University College of Medicine
Columbus, OH, United States

All of the relevant financial relationships listed below have been mitigated.
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MH

Marlene Hernandez, n/a

Medical Student
The Ohio State University College of Medicine
Columbus, Ohio, United States

Disclosure information not submitted.
JC Chen, MD (they/them/theirs)

Resident
Ohio State University
Ohio State University
Columbus, OH, United States

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Laura DeCesare, MD

Colorectal Surgery Fellow
The Ohio State University
The Ohio State University
Columbus, OH, United States

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MA

Madiha Aziz, MD

Colorectal Surgery Fellow
OSU
The Ohio State University
Columbus, OH, United States

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DB

Deborah Bartholomew, MD

Professor of OB/GYN
The Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
Matthew F. Kalady, MD, FACS, FASCRS

Professor of Surgery
The Ohio State University Wexner Medical Center
Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.

Senior Author(s)

Syed Husain, MB.,BS.

Associate Professor of Surgery-Clinical
Ohio State University
Ohio State University
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.

Purpose/Background: Anal cancer has historically been considered a disease predominantly impacting men who have sex with men (MSM). However, the review of SEER Cancer database suggests higher incident rates among women (2.3 cases/100,000 persons) than men (1.6 cases/100,000). While awareness of the importance of anal cancer screening in MSM is growing, screening among women with a history of genital dysplasia or cancer remains inadequate. Our study aims to assess the burden of anal dysplasia in women with genital dysplasia/cancer and the screening trends over the last five years.

Methods/Interventions: This is a single institution study where women ≥18 years with a history of a genital dysplasia or cancer between 2019-2023 were included. Genital dysplasia was defined as biopsy-proven cervical (CIN), vulvar (VIN), or vaginal (VAIN) intraepithelial neoplasm-1, 2, or 3. Of these, patients undergoing anal cancer screening and subsequent high-resolution anoscopy (HRA) were retrospectively reviewed. Biopsies that returned as anal intraepithelial neoplasia (AIN)-1 2, or 3 were defined as anal dysplasia. High-risk HPV (hrHPV), anal cytology, biopsy reports, HIV status, and hepatitis C status were also collected.

Results/Outcomes: During the study period, there were 97,966 cervical dysplasia/cancer patient encounters at our institution, of whom 305 (0.31%) underwent anal pap smears. Anal pap smear rates among women with genital dysplasia or cancer increased by 4-fold, from 0.16% in 2019 to 0.65% in 2023. There was a concomitant increase in cases of anal dysplasia, from 162 patients (0.88%) in 2019 to 298 patients (1.42%) in 2023. 254 women with a history of genital dysplasia/cancer who underwent anal pap smear were identified, of which 203 (80%) were considered satisfactory. 113 of the satisfactory pap smears (56%) (113 of 203) exhibited abnormalities prompting HRA exams. However, only 54 patients (47.8%) subsequently underwent HRA of which 35 (65%) returned with dysplasia including 16 (29.6%) with high-grade dysplasia (AIN2/3). Extrapolating these findings to the entire cohort, our research indicates that when screened in accordance with current guidelines, the prevalence of high-grade dysplasia in women with genital dysplasia/cancer is estimated to be 16.4%. Additionally, 69% tested positive for hrHPV, 9% for HIV, and 15% for Hepatitis C.

Conclusion/Discussion: This study underscores the necessity of anal cancer screening among women with history of genital dysplasia. Our findings also highlight the fact that a very small fraction of women with genital dysplasia undergo recommended screening for anal cancer. Although screening trends are increasing, rates remain low with < 1% of this high-risk group receiving appropriate screening. Widespread adoption of routine anal cancer screening in this patient population could potentially lead to earlier detection of anal dysplasia and prevent progression to anal cancer. To gain a more comprehensive understanding of anal cancer screening in patients with genital dysplasia, further multicenter studies are warranted.