Review Statistics and Preventive Strategies Related to Anal Cancer

Palefsky JM. Prevention of Anal Cancer in High-Risk Individuals. JAMA. 2024, in press.

This article reviews statistics and preventive strategies related to anal cancer.

The incidence of anal cancer is increasing in the US, with the highest incidence rate increase in patients aged 65–69 years with HIV infection. Patients with clinical AIDS comprise the highest risk group for developing anal cancer. Most cases are associated with human papilloma virus (HPV) infection.

Primary prevention is accomplished by providing HPV vaccination, while secondary prevention is accomplished with digital anal-rectal examination and anal swab surveillance to detect HPV infection and/or abnormal anal cytology.

In addition to detection of HPV infection and/or abnormal cytology, another important objective is to detect high-grade squamous intraepithelial lesions (HSIL). Removal of HSIL lesions before progression to cancer will lead to successful secondary prevention.

Patients with positive digital examinations and/or anal swab tests should undergo high resolution anoscopy with 5% acetic acid or Lugol iodine staining. The article emphasizes that high-resolution anoscopy requires specialized training.

If HSIL or cancer is detected, targeted ablation is performed using cautery, heat, or laser excision. Topical 5-FU cream may be used in selected patients. If high resolution anoscopy is not available, standard anoscopy may be used.

Evidence from one large, prospective randomized study cited in the article supports this approach for secondary prevention; the cited article is the resource used for the most recent clinical practice guidelines for prevention and early detection of anal cancer.