Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2016; 8(1): 41-51
Published online Jan 27, 2016. doi: 10.4240/wjgs.v8.i1.41
Anal cancer and intraepithelial neoplasia screening: A review
Ira L Leeds, Sandy H Fang
Ira L Leeds, Sandy H Fang, Ravitch Division, Colon and Rectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, United States
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.
Conflict-of-interest statement: Dr. Leeds reports no financial disclosures or funding sources; Dr. Fang reports receiving anal cancer research funding from the Maryland Department of Health and Hygiene Cigarette Restitution Fund; however this grant does not monetarily support this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Ira L Leeds, MD, MBA, Ravitch Division, Colon and Rectal Surgery, Department of Surgery, Johns Hopkins Hospital, 600 N Wolfe Street, Tower 110, Baltimore, MD 21287, United States. ileeds@jhmi.edu
Telephone: +1-410-9557323 Fax: +1-410-6149866
Received: June 25, 2015
Peer-review started: June 27, 2015
First decision: September 17, 2015
Revised: October 2, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: January 27, 2016
Abstract

This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening 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.

Keywords: Anal cancer, Secondary prevention, Anal Papanicolaou test, High-resolution anoscopy, Screening

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.