title: Are colon and rectal surgeons ready to screen for anal dysplasia? Results of a survey on attitudes and practice.
abstract: BACKGROUND
  Colorectal surgeons are ideal referral sources to screen for and treat high-grade anal dysplasia (high-grade squamous intraepithelial lesion [HSIL]) and anal cancer. Anal cytology and high-resolution anoscopy (HRA) using acetic acid and magnification are optimal methods for screening. We endeavored to determine US colorectal surgeons' attitudes and practices regarding HSIL screening.
  
  
  METHODS
  An Internet-based survey with questions related to clinician demographics and attitudes and practices regarding anal dysplasia was sent to US members of the American Society of Colon and Rectal Surgeons.
  
  
  RESULTS
  Of 1655 requests, 290 (18%) eligible participants responded. Most were white (83%), male (76%), board-certified colorectal surgeons (89%), and graduating medical school after 1990 (54%), almost all treated patients at risk for anal cancer and had read research on HSIL. Approximately one-third of respondents had performed anal cytology, and one-third had performed HRA. When evaluating patients for HSIL in surgery, only 31% use acetic acid with magnification. Of 99 participants who perform HRA, 46% were formally trained, 83% primarily do HRA primarily in the operating room, and 82% use acetic acid with magnification. Knowledge of HSIL risk factors was not associated with screening. Women, more recent graduates, and surgeons with higher percentages of HIV-infected patients were more likely to screen. Screening barriers included no training (52%), not a priority (23%), lack of evidence (21%), and cost (8%).
  
  
  CONCLUSIONS
  American Society of Colon and Rectal Surgeons members responding to the survey by and large do not screen for anal dysplasia. Those that do are often not formally trained and use inadequate technique.
authors.affiliation: From the *Departments of Medicine and †Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY; ‡Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil; and §Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Factor
authors.forename: Amy
authors.initials: A
authors.lastname: Cooperstein
authors.forename: Guilherme A
authors.initials: GA
authors.lastname: Pereira
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Goldstone
mesh_terms: D001003:Anal Canal / Q000473:pathology*; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000821:virology; D001291:Attitude of Health Personnel; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000821:virology; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003581:Cytodiagnosis; D004502:Education, Medical, Continuing; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000379:methods*; D030361:Papillomavirus Infections / Q000150:complications* / Q000473:pathology; D010818:Practice Patterns, Physicians'; D011351:Proctoscopy; D014481:United States / Q000453:epidemiology