P161 Anal Cancer Screening Practices: Current Expert Opinions

Background Anal cancer incidence is high among people with HIV (PWH), men who have sex with men (MSM), and women with lower genital tract disease (LGTD). Anal cancer is preceded by persistent high-risk human papillomavirus infection and subsequent high-grade squamous intraepithelial lesions (HSIL). Emerging screening practices may reduce anal cancer incidence. However, no national or international screening guidance exists. The International Anal Neoplasia Society (IANS) solicited expert opinion to understand preferred current anal screening practices. Methods IANS members and meeting attendees were invited to complete an online survey of screening practices. Screening initiation age, screening tool, and high resolution anoscopy (HRA) referral threshold were assessed. Recommendations for age and tool were delineated for PWH, sub-grouped female/non-MSM-male/MSM; and for women with LGTD, sub-grouped by disease (HSIL/cancer) and anatomic site (vulvar/cervico-vaginal). HRA referral threshold compared immunocompetent versus immunocompromised patients. Results Of 1150 individuals contacted, 140 (12%) participated and were included; 113 (81%) were HRA providers. Similar proportions of respondents specified a screening initiation age in all PWH (range 61–64%); however, there was no consensus for the specific age to begin screening for any PWH sub-group. More respondents preferred ’no age restriction’ for MSM (36%) compared to non-MSM-male counterparts (22%). Among LGTD groups, ’no age restriction’ was more commonly preferred (range 44–55%). Of tools, across all PWH and LGTD groups, cytology (79–89%) and digital anorectal exam (DARE) (73–83%) were most frequently recommended. For HRA referral threshold, ‘any abnormality’ was more often selected for both immunocompromised (56%) and immunocompetent (46%) patients than a specific cytology result (29%,36%). Among those who specified cytology, consensus was lacking and did not vary by immune status. Conclusion Respondents concurred cytology and DARE were preferred screening modalities. Screening initiation age and HRA referral threshold showed less consensus. Evidence-based guidance is needed and may lead to more consistent screening practices.