Anal cancer and intraepithelial neoplasia screening: A review

Abstract

and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screen-ing techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations. Core tip: Anal cancer is a low prevalence, highly morbid disease. With the success of secondary prevention practices for other human papilloma virus-associated malignancies, screening strategies may similarly decrease rates of anal cancer. No national guidelines formally support screening. This review summarizes possible screening modalities and what further evidence is needed to support routine screening for anal cancer. Leeds IL, Fang SH. Anal cancer and intraepithelial neoplasia screening: A review. World J Gastrointest Surg 2016; 8(1): 41-51 Available from: Author contributions: Leeds IL and Fang SH contributed to conception and design; Leeds IL contributed to data collection and analysis, and drafting manuscript; Fang SH contributed to critical revision. Abstract This review focuses on the early diagnosis of anal cancer REVIEW 41 January 27, 2016|Volume 8|Issue 1| WJGS|www.wjgnet.com