The Impact of the COVID-19 Pandemic on Anal Dysplasia Disease Surveillance in High-Risk Patients

Abstract

INTRODUCTION: Anal intraepithelial neoplasia (AIN) is premalignant lesion to anal cancer primarily caused by HPV infection. AIN is commonly screened for by anal cytology or health risk assessment. However, by March 13, 2020, the US was part of a global pandemic caused by the COVID-19 virus. As a result, non-urgent health care practices were disrupted and delayed, including those which needed scheduled surveillance and treatment for AIN. We explore effects of the pandemic on anal dysplasia progression and recurrence. METHODS: Data on patients managed with a diagnosis of dysplastic anal lesion was retrospectively reviewed from October 2019 to October 2021 (n = 168). Patients with anal dysplasia were managed at a large single urban institution using trichloroacetic acid, fulguration, and excision. The primary aim assessed recurrence during this time period. Secondary aims focused on the follow-up visits and postoperative complication. RESULTS: Demographically the pre-COVID and post-COVID cohorts were evenly matched in terms of age, height, weight, BMI, sex, and race with most patients being HIV-positive African American men. The average time between procedures was longer post-COVID (20.0 months) compared with the pre-COVID cohorts (15.8 months). The rate of recurrence (26.9% vs 31.0%) and time to recurrence in months (14.2 vs 14.3) were similar in the pre- and post-COVID cohorts, respectively (Table 1).CONCLUSION: Despite COVID-19 causing delay in procedures, the outcomes between the pre-COVID and post-COVID groups were similar, suggesting that we can safely delay surveillance in these patients beyond current guidelines.