Anal Papanicoloau Screening at Truman Clinic
Anal cancer is a squamous cell cancer associated with human papillomavirus (HPV), the same virus that is associated with cervical cancer. Although vaccination against HPV has been shown to be effective in reducing overall rates of infection, the number of new anal cancer cases has been rising for many years. In HIV-infected men and women, the incidence is even higher of anal cancer than in the general population. Current rates in an HIV-infected MSM population have been estimated to be as high as 70-144 per 100,000, with some studies of HIV-infected individuals showing that anal HPV infection is present in 93% of MSM and 76% of women, and that anal dysplasia (any grade) is present in 56% of MSM and 26% of women.
The current guidelines for screening for anal dysplasia and cancer in patients with HIV is to conduct annual digital anorectal screen (dare) for all patients with HIV ≥35 years old and thoseobtained, and if normal be performed annually thereafter. Currently, at Truman clinic, among the infectious disease fellow physicians, there is only 8.5% adherence rate to anal pap screening. This project will focus on improving education and anal pap screening on this population.
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Tamelet C, Ravaux I, Dhiver C, et al. Feasibility and Acceptability of Anal Self-Sampling for Human Papillomavirus Screening in HIV-Infected Patients. Intervirology 2016;59:118-122.
Cranston RD, Darragh TM, Holly EA, Jay N, Berry JM, Da Costa M, Efird JT, Palefsky JM: Self-collected versus clinician-collected anal cytology specimens to diagnose anal intraepithelial neoplasia in HIV-positive men. J Acquir Immune Defic Syndr 2004;36:915-920.
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Tran, Peter D. and Harshdeep Babbar. "Anal Cancer Screening at Truman Health Services." (2021). https://digitalrepository.unm.edu/hsc_qips/69
Presented at the University of New Mexico GME/CPL 2021 Annual Quality Improvement and Patient Safety Symposium.