Abstract
Anal cancer is potentially preventable through screening. For screening to be implemented, the screening procedures must be acceptable to the affected population. The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a population of women living with hiv who had experienced the tests. The evva study ("Evaluation of Human Immunodeficiency Virus, Human Papillomavirus, and Anal Intraepithelial Neoplasia in Women") is a prospective cohort study of adult women living with hiv in Montreal, Quebec. Participants were screened with cervical or anal hpv testing and cervical or anal cytology every 6 months for 2 years. High-resolution anoscopy (hra) and digital anal rectal examination (dare) were also performed systematically, with biopsies, at baseline and at 2 years. An acceptability questionnaire was administered at the final visit or at study withdrawal. Of 124 women who completed the acceptability questionnaire, most considered screening "an absolute necessity" in routine care for all women living with hiv [77%; 95% confidence interval (ci): 69% to 84%]. Yearly anal cytology or anal hpv testing was considered very acceptable by 81% (95% ci: 73% to 88%); hra every 2 years was considered very acceptable by 84% (95% ci: 77% to 90%); and yearly dare was considered very acceptable by 87% (95% ci: 79% to 92%). Acceptability increased to more than 95% with a longer proposed time interval. Pain was the main reason for lower acceptability. Most participating women considered anal cancer screening necessary and very acceptable. Longer screening intervals and adequate pain management could further increase the acceptability of repeated screening.
Highlights
The incidence of anal cancer is increasing in the general population, and men and women living with hiv are the population at highest risk[1,2,3]
Anal cytology or anal hpv testing was considered very acceptable by 81% (95% ci: 73% to 88%); hra every 2 years was considered very acceptable by 84% (95% ci: 77% to 90%); and yearly dare was considered very acceptable by 87% (95% ci: 79% to 92%)
We assessed the acceptability of anal cancer screening within the evva study (“Evaluation of Human Immunodeficiency Virus, Human Papillomavirus, and Anal Intraepithelial Neoplasia in Women”), a prospective observational cohort study of 151 women living with hiv[34]
Summary
The incidence of anal cancer is increasing in the general population, and men and women living with hiv are the population at highest risk[1,2,3]. The rate of progression of anal hsil to invasive anal cancer remains uncertain[8], there is growing evidence that treatment of anal hsils reduces progression to cancer[9]. We know that early detection and treatment of invasive anal cancer reduces mortality[10]. Anal hsils can be effectively treated[17], evidence that treatment of hsils reduces the incidence of anal cancer is scarce. Ongoing randomized controlled trials are assessing the efficacy of identifying and treating anal hsils for prevention of invasive anal cancer (see NCT02135419 at https://ClinicalTrials.gov, https://anchorstudy.org/, and ISRCTN14067023 at http://apps.who.int/trialsearch/ Default.aspx). The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a population of women living with hiv who had experienced the tests
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