Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines: practitioners’ perspectives

  • Alexis M. KoskanEmail author
  • Stephanie A. Brennhofer
  • Deborah L. Helitzer
Original Paper



Immunocompromised populations including people living with HIV (PLWH) suffer disproportionate burden from anal cancer, a rare cancer caused by persistent infection of the anal canal with oncogenic strains of human papillomavirus. In the US, there are no nationally adopted screening guidelines for anal cancer. In the absence of such guidelines, this study explores healthcare practitioners’ screening practices for early signs of anal cancer among PLWH.


Between November 2017 and June 2018, the research team completed 25 interviews among a diverse sample of healthcare practitioners who provide care for PLWH.


Providers expressed frustration that screening and treatment guidelines for anal cancer were scant, and they varied in their screening practices. The majority of providers screened PLWH for anal dysplasia via the anal Pap smear; few providers were trained and had the medical equipment to conduct high-resolution anoscopy-guided biopsies, a more sensitive and specific screening method. Others screened through digital ano-rectal examinations (DARE) and both visually and with a DARE. Participants discussed how providers may be over-treating their patients who have high-grade anal intraepithelial neoplasia (AIN) and the role of biomarkers to determine whether the lesion is carcinogenic.


Practitioners who provide care for PLWH are proactive in screening to help prevent and control anal cancer, a rare and slow-growing disease. Continuing to regularly surveil high-risk populations, particularly PLWH previously diagnosed with high-grade lesions, is critical to prevent and control anal cancer.


Anal cancer Anal intraepithelial neoplasia Human papillomavirus Human immunodeficiency virus 



This research was funded by a grant from the Arizona Area Health Education Centers (AHEC) Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of Arizona AHEC.

Compliance with ethical standards

Conflict of interest

All authors present no potential conflicts of interest.

Ethical approval

This study received institutional review board approval, and all participants completed informed consent prior to participating in this study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.College of Health SolutionsArizona State UniversityPhoenixUSA
  2. 2.Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonUSA
  3. 3.College of Health SolutionsArizona State UniversityPhoenixUSA

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