The incidence of anal cancer is increasing in all women. Women at particularly increased risk of developing anal cancer include those living with HIV or have a history of non-anal HPV-related cancer. Detection of anal HSIL followed by treatment may prevent progression of anal HSIL to cancer. However, detection of anal HSIL can be difficult. There is not yet concensus on who should be screened and how that screening should be done.
Targeted screening has been suggested for women over age 35 who also have one of the following risk factors:
1) Infection with HIV
2) History of cervical, vaginal or vulvar cancer
3) History of CIN2+, VAIN2+ or VIN2+
4) Chronic immune suppression from other causes (e.g., organ transplantation, autoimmune disease)
Screening options include obtaining history of anal symptoms potentially related to anal cancer, digital anal rectal exam (DARE), anal cytology, anal HPV testing, and high resolution anoscopy (HRA) with directed biopsies. Anal cytology should not be used for screening unless HRA facilities are available.