Editorial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2022; 14(2): 369-374
Published online Feb 15, 2022. doi: 10.4251/wjgo.v14.i2.369
Anal human papilloma viral infection and squamous cell carcinoma: Need objective biomarkers for risk assessment and surveillance guidelines
Santosh Shenoy
Santosh Shenoy, General Surgery, Kansas City VA Medical Center, University of Missouri - Kansas City, MO 64128, United States
Author contributions: Shenoy S conceived, researched and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to disclose or any funding for this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Santosh Shenoy, FACS, MD, Professor, Surgeon, General Surgery, Kansas City VA Medical Center, University of Missouri - Kansas City, 4801 E Linwood, Kansas City, MO 64128, United States. shenoy2009@hotmail.com
Received: July 12, 2021
Peer-review started: July 12, 2021
First decision: October 3, 2021
Revised: October 4, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: February 15, 2022
Abstract

High grade anal intraepithelial neoplasia due to human papilloma viral (HPV) infections is a precursor lesion for squamous cell carcinoma especially in high risk populations. Frequent examination and anal biopsies remain unpopular with patients; moreover they are also risk factors for chronic pain, scarring and sphincter injury. There is lack of uniform, surveillance methods and guidelines for anal HPV specifically the intervals between exam and biopsies. The aim of this editorial is to discuss the intervals for surveillance exam and biopsy, based on specific HPV related biomarkers? Currently there are no published randomized controlled trials documenting the effectiveness of anal screening and surveillance programs to reduce the incidence, morbidity and mortality of anal cancers. In contrast, the currently approved screening and surveillance methods available for HPV related cervical cancer includes cytology, HPV DNA test, P16 or combined P16/Ki-67 index and HPV E/6 and E/7 mRNA test. There are very few studies performed to determine the efficacy of these tests in HPV related anal pre-cancerous lesions. The relevance of these biomarkers is discussed in this editorial. Longitudinal prospective research is needed to confirm the effectiveness of these molecular biomarkers that include high risk HPV serotyping, P16 immuno-histiochemistry and E6/E7 mRNA profiling on biopsies to elucidate and establish surveillance guidelines.

Keywords: Anal cancer, Biomarkers, P16, E6/E7 mRNA, Human papilloma viral DNA

Core Tip: Human papilloma viral (HPV) infections are the most common sexually transmitted infection worldwide and are causally associated with 5%-10% of all cancers. High grade anal intraepithelial neoplasia (anal intraepithelial neoplasia-3, high-grade squamous intraepithelial lesion, carcinoma in situ) is a precursor for anal carcinoma. There is inconsistency and unpredictability of anal dysplasia and its progression to squamous cell cancer. There is an urgent need to identify and validate objective HPV biomarkers for better risk stratification for anal cancers. Extrapolating the data from cervical cancers, prospective longitudinal studies are needed incorporating high risk HPV genotyping testing, E6/E7 mRNA; and P16/Ki67 index on anal biopsies to establish optimal surveillance intervals.