QS139 - Save the Bottoms!!! at Pride: Report of a Successful Community Event-Based Novel Anal Cancer Screening Protocol

Purpose/Background: Men who have sex with men (MSM) are a high-risk population for anal cancer, but screening for anal dysplasia, a known precursor, remains low. MSM have previously demonstrated the ability to perform anal self-swab in clinic with comparable rates of satisfactory samples to clinicians. However, this screening modality has not been described outside of the clinic setting. We hypothesized that an anal self-swab unit at an LGBT-focused community event would be both feasible and acceptable for anal cancer screening.

Methods/Interventions: The study took place at our city’s Pride festival, June 24-25, 2023. The unit included two 10x10-foot spaces, one fully enclosed, to facilitate recruitment, consent, and self-swab. Eligible participants were adults ≥18, assigned male sex at birth, with no previous anal dysplasia. Participants used their mobile phones to complete pre- and post-swab surveys and access an animated video of the self-swab technique. Instruction was also provided by on-site clinicians. Analysis was conducted by cytopathologists with expertise in anal dysplasia. Participants were contacted via e-mail or phone to disclose results; those with any cytologic abnormalities (ASCUS or higher) were invited for High-Resolution Anoscopy (HRA).

Results/Outcomes: Enrollment was 101 MSM individuals over 14 hours of recruitment. The majority were white, cisgender, with median age 32 (range 18-79 years). Fourteen individuals self-described as transgender or non-binary and 10% endorsed living with HIV. Seventy-four percent expressed at least some concern over their lifetime risk of anal cancer and 51% believed their risk was higher than the average US population. Approximately two-thirds of participants had received the HPV vaccine. Significantly more participants under age 40 had received the HPV vaccine (81%, N=50 vs. 42%, N=15, p< 0.01). Fifty-eight percent had heard of anal swabs for HPV-related anal disease screening, but only 35% were aware of HRA. All but four swabs (97%) were self-administered. The remainder were performed by an on-site clinician per participant request. A limitation to participation was the availability of study staff to accommodate the intake and consent process for interested individuals, as well as space to perform the self-swab, resulting in long wait times for study completion.

Cytologic examination demonstrated 23 specimens with inadequate sampling, similar to that reported for clinician-administered anal swabs. Of the remainder, 13 had abnormal cytology; there was no difference in positive screening between individuals under 40 vs. 40 and older. Eleven of the participants with abnormal cytology were successfully contacted and 9 agreed to undergo HRA (Figure 1). Four HRA appointments have been completed, with one diagnosis of low-grade and one diagnosis of high-grade dysplasia (Figure 1).

Conclusion/Discussion: Anal self-swab for cancer screening at an LGBT-focused community event is feasible and acceptable. Further iterations will aim to improve participant diversity, especially in age and race; include high-risk HPV subtyping; and increase space and research staff availability to accommodate the high interest in this innovative screening modality.