WE NEED DATA ON ANAL SCREENING EFFECTIVENESS BEFORE FOCUSING ON INCREASING IT

Abstract

We are concerned that the article by Reed et al. on gay and bisexual men's willingness to receive anal Papanicolaou (Pap) screening1 perpetuates the belief that such screening has been shown to be effective. This is not the case. No prospective studies have demonstrated that performance of anal screening reduces the incidence of invasive anal cancer or of death as a result of cancer.2 The authors’ statement that “it is promising that potential benefits of anal cancer screening for gay and bisexual men are comparable to observed benefits of cervical cancer screening for women”1(p1127) is tautological. Because the effectiveness of anal screening in gay and bisexual men is unknown, the two cited analyses3,4 assume that the effectiveness of treating lesions found using anal screening in men is similar to that of treating lesions found by using cervical screening in women. It is certainly possible that anal screening with Pap smears is an effective method of reducing invasive cancer. However, given the cost, the anxiety experienced by patients told that they have an abnormal anal Pap, and the discomfort caused by the treatment of lesions found through anal screening, the practice needs to be proven effective before we focus on encouraging more people to be tested.5 We should not advocate for spending scarce health dollars on medical procedures of no proven effectiveness when there are so many proven interventions that are not available to all who need them.