{"id":961,"date":"2010-06-02T14:47:28","date_gmt":"2010-06-02T18:47:28","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=961"},"modified":"2015-06-04T15:25:07","modified_gmt":"2015-06-04T19:25:07","slug":"screening-for-anal-cancer-and-the-worlds-worst-job","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/screening-for-anal-cancer-and-the-worlds-worst-job\/2010\/06\/02\/","title":{"rendered":"Screening for Anal Cancer and the World’s Worst Job"},"content":{"rendered":"

\"fixingIn Journal Watch AIDS Clinical Care, <\/em>we published a simple case:\u00a0 Clinically stable HIV+ gay man, on HIV treatment; anal pap comes back with\u00a0“atypical squamous cells of undetermined significance” (ASCUS).<\/p>\n

What to do with this result?\u00a0 Two experts weighed in<\/a>,\u00a0Howard Libman and Joel Gallant.\u00a0 In Howard’s thoughtful response, he acknowledges the limitations of the data thus far, but\u00a0said he would refer the patient for high-resolution anoscopy (HRA) and biopsy — which is what most of our readers said <\/a> as well.<\/p>\n

But Joel acknowledges that, despite an institutional protocol to refer all such patients,\u00a0he wavers a bit for those with ASCUS:<\/p>\n

I have been bending the rules in patients with ASCUS and monitoring them with yearly Pap smears rather than referring them for HRA. I do this with the understanding that the Pap smear provides an imprecise measurement of the true grade of dysplasia and that those with ASCUS could have higher grades on biopsy. However, I have to weigh that risk with the fact that my patients don’t enjoy going through HRA, biopsy, and ablation, that the parallels between anal and cervical dysplasia aren’t perfect, and that the protocols around anal Pap smear are written without much evidence backing them up.<\/p><\/blockquote>\n

It’s safe to say that we don’t really know yet what to do — not in this situation, nor in multiple other scenarios involving anal cancer screening.<\/p>\n

Just a few questions to ponder:\u00a0 How frequently (if at all) should anal paps be done?\u00a0 If the sensitivity is so poor, why not refer all gay men for HRA\/biopsy, skip the pap?\u00a0 Or should it be limited to those with a history of condyloma?\u00a0\u00a0(Read this concerning paper<\/a>.)\u00a0 Or should those patients\u00a0go right to biopsy?\u00a0 Should HPV testing be done in all patients?\u00a0 What anal cancer screening should be done in HIV-infected women?\u00a0\u00a0\u00a0Or should this just be done\u00a0in women with cervical disease?<\/p>\n

If the evidence were stronger, clearly the Primary Care<\/a> and OI Prevention Guidelines<\/a> would recommend a standard screening protocol.<\/p>\n

But until then, one hear’s the voice of Joel Palefsky — owner of the “World’s Worst Science Job”<\/a> — as he highlights the benefits of\u00a0preventing\u00a0a common, potentially life-threatening and disfiguring cancer.\u00a0 In response to his (and other’s) work,\u00a0 a diverse range of\u00a0practitioners out there (PCPs, ID docs, gynecologists, dermatologists, surgeons) now offer high-resolution anoscopy with biopsy for this indication.<\/p>\n

But is screening for cancer always the right thing to do?<\/p>\n","protected":false},"excerpt":{"rendered":"

In Journal Watch AIDS Clinical Care, we published a simple case:\u00a0 Clinically stable HIV+ gay man, on HIV treatment; anal pap comes back with\u00a0“atypical squamous cells of undetermined significance” (ASCUS). What to do with this result?\u00a0 Two experts weighed in,\u00a0Howard Libman and Joel Gallant.\u00a0 In Howard’s thoughtful response, he acknowledges the limitations of the data […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5,8,9],"tags":[],"class_list":["post-961","post","type-post","status-publish","format-standard","hentry","category-hiv","category-infectious-diseases","category-patient-care","category-policy"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/961","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=961"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/961\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=961"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=961"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=961"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}