Letter to the Editor

Anal Pap Smear in High-Risk Patients: A Poor Screening Tool

Authors: Ambra Ferraris, MD, Kanakasabai Narasimhan, MD, Ifad Rahman, MD, Irving Jorge, MD


To the Editor:

Anal cancer and anal intraepithelial neoplasia are rare in the general US population, with an incidence of 0.8 per 100,000.1 This incidence is increased by 25 to 50 times in homosexuals, and further increased in patients with AIDS. The association of human papillomavirus (HPV) infection with cervical neoplasia in women has been well documented in the literature. It is from this experience that the association of HPV with anal cancer is assumed. However, there are multiple factors influencing the development of anal cancer, including human immunodeficiency virus (HIV) seropositivity and a history of sexually transmitted infections and participation in anally receptive intercourse.2,3 The controversy surrounding routine cytological screening for intra-anal HPV stems from the unknown natural history of HPV infection and the absence of any cure. This study was designed to assess the accuracy of anal Pap smears in predicting the histological grade of anal intraepithelial lesions and in detecting anal cancer.

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1.Chiao EY, Krown SE, Stier EA, et al. A population-based analysis of temporal trends in the incidence of squamous anal canal cancer in relation to the HIV epidemic. J Acquir Immune Defic Syndr 2005;40:451–455.
2.Palefsky JM, Holly EA, Gonzales J, et al. Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res 1991;51:1014–1019.
3.Palefsky JM, Holly EA, Hogeboom CJ, et al. Anal cytology as a screening tool for anal squamous intraepithelial lesions. J Acquir Immune Defic Syndr Hum Retrovirol 1997;14:415–422.
4.Goldie SJ, Kuntz KM, Weinstein MC, et al. Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus-negative homosexual and bisexual men. Am J Med 2000;108:634–641.
5.Goldie SJ, Kuntz KM, Weinstein MC, et al. The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA 1999;281:1822–1829.