Anal cancer and intraepithelial neoplasia screening: A review

Table 1 Summary characteristics of anal cancer screening modalities

	DARE	Anal Pap test	HPV testing	High resolution anoscopy
Sensitivity[56,57,61,62,101]	Not studied	69%-93%	Alone: 100%	Current diagnostic standard
			Co-testing with Pap[49]: 72%-96%
Specificity[56,57,61,62,101]	Not studied	32%-59%	Alone: 16%	Current diagnostic standard
Resource availability	N/A	Ubiquitous	Ubiquitous	Highly selective centers
Provider availability	Universal	Specialty clinics	Specialty clinics	Highly selective centers
Learning curve	Part of usual clinical training	Part of usual clinical training	Part of usual clinical training	> 200 cases
Current consensus[52]	Annually, all HIV-positive patients	Annually in highest-risk groups	Alone: No recommendation	Second-line screen following positive Pap test
			Co-testing: No recommendation

DARE: Digital anorectal exam; HPV: Human papilloma virus; N/A: Not applicable; HIV: Human immunodeficiency virus; Pap: Papanicolaou.

Table 2 Professional society recommendations for anal cancer screening

	Routine screening of general population	Routine screening of high-risk individuals	Assesses modalities for diagnosis	Specific modalities assessed
American Society of Colon and Rectal Surgeons[54]	No recommendation	No recommendation	Screening and surveillance	Anal Pap test, high-resolution anoscopy
European Society of Medical Oncology	No recommendation	No recommendation	Surveillance only	Digital anorectal exam, standard anoscopy, computed tomography, magnetic resonance imaging
European Society of Surgical Oncology
European Society for Therapeutic Radiation and Oncology[102]
National Comprehensive Cancer Network[103]	No recommendation	No recommendation	Surveillance only	Digital anorectal exam, standard anoscopy
Centers for Disease Control and Prevention[104]	No recommendation	No recommendation	Screening and surveillance	Digital anorectal exam, HPV testing
New York State Department of Health[52]	No recommendation	All HIV infected adults	Screening only	Digital anorectal exam, anal Pap test, high resolution anoscopy
HIV Medicine Association of the Infectious Diseases Society of America[20]	No recommendation	Men who have sex with men, women with a history of abnormal cervical Pap tests, and all HIV-positive persons with genital warts	Screening only	Digital anorectal exam, HPV co-testing, anal Pap test, high resolution anoscopy
British HIV Association[21]	No recommendation	No recommendation	Screening and surveillance	Digital anorectal exam, anal Pap test, high resolution anoscopy

HIV: Human immunodeficiency virus; HPV: Human papilloma virus; Pap: Papanicolaou.