scholarly journals Screening for Anal Cancer in Women With a History of Vulvar High-Grade Squamous Intraepithelial Lesions

2019 ◽  
Vol 23 (4) ◽  
pp. 265-271 ◽  
Author(s):  
Lily Proctor ◽  
Troy Grennan ◽  
Arianne Albert ◽  
Dianne Miller ◽  
Leslie Sadownik ◽  
...  
Keyword(s):  
Anal Cancer ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
History Of ◽  
Intraepithelial Lesions

scholarly journals Progression of anal high‐grade squamous intraepithelial lesions to invasive anal cancer among HIV‐infected men who have sex with men

2013 ◽  
Vol 134 (5) ◽  
pp. 1147-1155 ◽  
Author(s):  
J. Michael Berry ◽  
Naomi Jay ◽  
Ross D. Cranston ◽  
Teresa M. Darragh ◽  
Elizabeth A. Holly ◽  
...  
Keyword(s):  
Anal Cancer ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Sex With Men ◽  
Intraepithelial Lesions

scholarly journals Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus

2019 ◽  
Vol 70 (8) ◽  
pp. 1701-1707 ◽  
Author(s):  
Elizabeth A Stier ◽  
Shelly Y Lensing ◽  
Teresa M Darragh ◽  
Ashish A Deshmukh ◽  
Mark H Einstein ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
High Resolution ◽  
The United States ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Intraepithelial Lesions

Abstract Background Women living with human immunodeficiency virus (WLHIV) have disproportionately high rates of squamous cell carcinoma of the anus compared with the general population of women. Anal high-grade squamous intraepithelial lesions (HSILs) precede anal cancer, and accurate studies of HSIL prevalence among WLHIV in the United States are lacking. Methods The AIDS Malignancy Consortium 084 study was a multicenter national trial to evaluate the prevalence of and risk factors for anal HSIL in a US cohort. Eligible participants were WLHIV aged ≥18 years with no history of anal HSIL. Study participants had an examination including collection of cervical/vaginal and anal specimens, followed by high-resolution anoscopy with biopsy. Results We enrolled 256 women with evaluable anal pathology. The mean age was 49.4 years, 64% women were non-Hispanic black, 67% were former or current smokers, and 56% reported ever having anal sex with a man. The median CD4 T-cell count was 664 cells/μL. The prevalence of anal histologic HSIL (hHSIL) was 27% (95% confidence interval [CI], 22%–33%). There was a strong concordance (240/254) between local and consensus pathologists for hHSIL vs less than hHSIL (κ = 0.86 [95% CI, .79–.93]). Current CD4 count of ≤200 cells/μL was the strongest predictor of consensus anal hHSIL diagnosis (adjusted odds ratio [aOR], 10.34 [95% CI, 3.47–30.87]). History of anoreceptive intercourse was also associated with hHSIL (aOR, 2.44 [95% CI, 1.22–4.76]). Conclusions The prevalence of anal hHSIL in WLHIV in the United States was 27% in this study where all participants received high-resolution anoscopy and biopsy.

scholarly journals High Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines

2016 ◽  
Vol 64 (3) ◽  
pp. 289-294 ◽  
Author(s):  
Michael Gaisa ◽  
Fanny Ita-Nagy ◽  
Keith Sigel ◽  
Yotam Arens ◽  
Mary Ann Hennessy ◽  
...  
Keyword(s):  
Sexual Practices ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Screening Guidelines ◽  
Secondary Screen ◽  
Immunodeficiency Virus ◽  
Anal Cytology ◽  
Receptive Anal Sex ◽  
History Of ◽  
Intraepithelial Lesions

Abstract Background Human immunodeficiency virus (HIV)–infected women have a higher burden of anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) compared with HIV-uninfected women. Guidelines for AC screening in this population are heterogeneous. Here we report outcomes and risk factors for anal HSIL following implementation of universal AC screening offered to all HIV-infected women. Methods Data from women who underwent AC screening with anal cytology from April 2009 to July 2014 were analyzed. Routine clinical data included anal and cervical cytology, demographic/behavioral data, and high-resolution anoscopy (HRA) results. We evaluated the association of cytology with HRA results, and predictors of HSIL pathology, and compared rates of HSIL pathology among women meeting screening guidelines to those who did not. Results Seven hundred forty-five HIV-infected women were screened with anal cytology. Thirty-nine percent had abnormal anal cytology on initial screen and 15% on secondary screen; 208 women underwent HRA following abnormal anal cytology. HSIL was found in 26% and 18% of anal biopsies following initial and secondary screening, respectively. One woman had AC. Cigarette smoking more than doubled HSIL risk. Among women who underwent AC screening despite not meeting existing guideline criteria, 21% and 10%, respectively, were found to have HSIL on biopsy. Neither meeting criteria for screening nor history of receptive anal sex was significantly associated with HSIL. Conclusions Anal HSIL is common in HIV-infected women. Substantial numbers of HSIL would have been missed by strictly adhering to existing AC screening guidelines. These results support routine screening of all HIV-infected women regardless of human papillomavirus history or sexual practices.

18. Topical 5% 5-flourouracil (t5FU) for treatment of diffuse anal high-grade squamous intraepithelial lesions (aHSIL)

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 578
Author(s):  
Naomi Jay ◽  
J. Michael Berry ◽  
Tara Walhart ◽  
Teresa Darragh
Keyword(s):  
Side Effects ◽  
Partial Response ◽  
Clinical Improvement ◽  
Anal Cancer ◽  
Complete Response ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Ablative Therapy ◽  
Intraepithelial Lesions ◽  
Female Genital

Background Treatment of anal high-grade squamous intraepithelial lesions (aHSIL) may prevent anal cancer. Options for treatment of diffuse lesions include staged ablation, often requiring surgery, although in-office treatment is preferable. Topical 5% 5-fluorouracil (t5FU) has been used to treat diffuse female genital HPV-associated disease. We report our experience using t5FU for treatment of diffuse aHSIL considered unsuitable for ablation, to evaluate its tolerability and efficacy. Methods: Patients were given t5FU for treatment of diffuse aHSIL in doses of 0.5 mL self-applied 2× daily for 5 days followed by 9 days off. Patients were assessed on average following 4–8 cycles for complete response (CR), defined as the absence of HSIL on exam, cytology and/or histology, or partial response (PR), defined as a reduction in the amount of disease. Patients with PR then received ablative therapy. Results: 73 patients (55 HIV infected, 18 uninfected) were treated, including 13 women and 60 men. In 69 patients who used t5FU for at least one cycle, CR occurred in 8 (~11%) patients, 53 (~77%) had a partial response indicating reduction of disease, 6 (9%) had no response, and 1 had more widespread disease, 1 chart was not evaluable. Treatment was discontinued after <1 cycle in 4 patients due to side effects. Patients with PR were treated successfully with in-office ablation, except 2 patients referred for surgery. Conclusions: t5FU was well tolerated although side effects occur. Most patients had clinical improvement, suggesting that t5FU may play an important role in aHSIL treatment. Further studies may determine its optimal use.

32. HPV type and strain variant concordance between anal cancers and their preceding high-grade squamous intraepithelial lesions

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 585
Author(s):  
Joel Palefsky ◽  
Maria Da Costa ◽  
Teresa M. Darragh ◽  
Naomi Jay ◽  
J. Michael Berry
Keyword(s):  
Anal Cancer ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Hpv 16 ◽  
Hpv Dna ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Location Methods ◽  
Intraepithelial Lesions

Background Anal high-grade squamous intraepithelial lesions (HSIL) are frequently found overlying anal cancer on histology, and anal cancer has been observed to develop in the same location as previously diagnosed anal HSIL. These observations support the role of HSIL as the direct precursor lesion to anal cancer. To further investigate a direct pathogenetic relationship between anal HSIL and cancer, we typed and sequenced HPV DNA in anal HSIL and the cancers that subsequently developed in the same location. Methods: Tissues samples were analysed from 15 HIV-infected men followed at UCSF in whom anal cancer developed at a previously biopsied site of HSIL. Formalin-fixed paraffin-embedded pairs of HSIL and cancer were typed for HPV DNA using L1 PCR. HPV 16-positive samples underwent E6-based strain variant analysis. Results: Nine matched pairs for which DNA from both HSIL and cancer were available were analysed. Eight pairs (89%) contained HPV 16 DNA. One (11%) contained both HPV 18 and 51 in both samples. Of the eight HPV 16-positive pairs, each pair contained the same HPV 16 strain variant. Four contained the Eur-350T variant alone, and one contained Eur-350T in both the HSIL and cancer, with an additional 426T variant in the cancer. One pair contained both Eur-350T and 457C in both the HSIL and the cancer. Two pairs contained the Eur-350G variant alone. Conclusions: Concordance of both the HPV type and strain variant in anal cancers and their site-matched preceding HSIL further supports the role of anal HSIL as an anal cancer precursor.

Assessment of Anal Cancer Screening Tools in Detecting High-Grade Anal Squamous Intraepithelial Lesions in Women

2020 ◽  
Vol 24 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Jeslie M. Ramos-Cartagena ◽  
Cynthia M. Pérez ◽  
Humberto M. Guiot ◽  
Claudia P. Amaya-Ardilla ◽  
Maribel Tirado-Gómez ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Anal Cancer ◽  
Screening Tools ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Anal Squamous Intraepithelial Lesions ◽  
Anal Cancer Screening ◽  
Intraepithelial Lesions

The Natural History of Anal High-grade Squamous Intraepithelial Lesions in Gay and Bisexual Men

2020 ◽  
Author(s):  
I Mary Poynten ◽  
Fengyi Jin ◽  
Jennifer M Roberts ◽  
David J Templeton ◽  
Carmella Law ◽  
...  
Keyword(s):  
Natural History ◽  
Gay And Bisexual Men ◽  
Hiv Positive ◽  
High Grade ◽  
Bisexual Men ◽  
Squamous Intraepithelial Lesions ◽  
History Of ◽  
And Bisexual ◽  
Intraepithelial Lesions

Abstract Background Gay and bisexual men (GBM) are disproportionately affected by anal cancer. Prevention is hindered by incomplete understanding of the natural history of its precursor, anal high-grade squamous intraepithelial lesions (HSIL). Methods The Study of the Prevention of Anal Cancer, conducted between 2010 and 2018, enrolled human immunodeficiency virus (HIV)-positive and HIV-negative GBM aged ≥35 years. Anal cytology and high-resolution anoscopy (HRA) were performed at baseline and 3 annual visits. A composite HSIL diagnosis (cytology ± histology) was used. Cytological high-grade squamous intraepithelial lesions (cHSIL) incidence and clearance rates were calculated with 95% confidence intervals (CIs). Predictors were calculated using Cox regression with hazard ratios (HRs) and 95% CIs. Results Among 617 men, 220 (35.7%) were HIV-positive, median age 49 years. And 124 incident cHSIL cases occurred over 1097.3 person-years (PY) follow-up (11.3, 95% CI 9.5–13.5 per 100 PY). Significant bivariate predictors of higher incidence included age &lt;45 years (HR 1.64, 95% CI 1.11–2.41), HIV positivity (HR 1.43, 95% CI .99–2.06), prior SIL diagnosis (P-trend &lt; .001) and human papillomavirus (HPV)16 (HR 3.39, 2.38–4.84). Over 695.3 PY follow-up, 153 HSIL cleared (clearance 22.0, 95% CI 18.8–25.8 per 100 PY). Predictors were age &lt; 45 years (HR 1.52, 1.08–2.16), anal intraepithelial neoplasia (AIN)2 rather than AIN3 (HR 1.79, 1.29–2.49), smaller lesions (HR 1.62, 1.11–2.36) and no persistent HPV16 (HR 1.72, 1.23–2.41). There was 1 progression to cancer (incidence 0.224, 95% CI .006–1.25 per 100 PY). Conclusion These data strongly suggest that not all anal HSIL detected in screening requires treatment. Men with persistent HPV16 were less likely to clear HSIL and are more likely to benefit from effective HSIL treatments.

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