title: A prospective study of anal cancer screening in HIV-positive and negative MSM.
abstract: The study sought to establish the feasibility and acceptability of anal screening among men MSM.
  
  
  
  Prospective cohort study.
  
  
  
  Sexual health clinics in tertiary care.
  
  
  
  Known HIV-positive and negative MSM who have anoreceptive intercourse.
  
  
  
  Anal screening with human papilloma virus (HPV) testing, liquid-based cytology and high-resolution anoscopy with biopsy of anoscopic abnormalities. Participants completed questionnaires at baseline and at 6 months.
  
  
  
  Anal HPV was highly prevalent in MSM (HIV-positive, 88% and HIV-negative, 78%). Despite the high prevalence of cytological abnormality in both HIV-positive (46.2%) and negative (35.0%) MSM, almost half of anal intraepithelial neoplasia (AIN) of all grades were associated with negative cytology. Anoscopically directed biopsies detected AIN3 or worse (AIN3+) in 14 of 203 (6.9%) of HIV-positive MSM and three of 81 (3.7%) HIV-negative MSM. The corresponding prevalence of AIN2+ was 26.6 and 20.9%, respectively. One case of AIN3 was detected at the second visit. Screening was considered to be highly acceptable by participants.
  
  
  
  The high prevalence of high-risk-HPV and frequency of false negative cytology in this study suggest that high-resolution anoscopy would have most clinical utility, as a primary screening tool for anal cancer in a high-risk group. The prevalence of AIN3+ in HIV-positive MSM lends support for a policy of screening this group, but the high prevalence of lower grade lesions which do not warrant immediate treatment and the limitations of treating high-grade lesions requires careful consideration in terms of a screening policy.
authors.affiliation: aInstitute of Cancer Sciences, The University of Manchester bCentre for Biostatistics, Institute of Population Health, The University of Manchester cManchester Cytology Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester dClinical Virology, Central Manchester University Hospitals NHS Foundation Trust, Manchester eDepartment of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester fGeneral Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester gPublic Health England, Sheffield, UK.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Schofield
authors.forename: Laura
authors.initials: L
authors.lastname: Sadler
authors.forename: Linsey
authors.initials: L
authors.lastname: Nelson
authors.forename: Matthew
authors.initials: M
authors.lastname: Gittins
authors.forename: Mina
authors.initials: M
authors.lastname: Desai
authors.forename: Alex
authors.initials: A
authors.lastname: Sargent
authors.forename: Raymond F T
authors.initials: RF
authors.lastname: McMahon
authors.forename: James
authors.initials: J
authors.lastname: Hill
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Crosbie
authors.forename: Julietta
authors.initials: J
authors.lastname: Patnick
authors.forename: Henry C
authors.initials: HC
authors.lastname: Kitchener
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000175:diagnosis*; D001706:Biopsy; D003584:Cytological Techniques; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004724:Endoscopy; D015658:HIV Infections / Q000150:complications; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010336:Pathology; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires