Letter to the Editor
Anal Pap Smear in High-Risk Patients: A Poor Screening Tool
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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