Anal cancer screening prevalence in US cities and factors associated with screening.
Annual anal cancer screening for sexual minority men and transgender women with HIV has been recommended by experts for more than 15 years and is now endorsed by the United States Department of Health and Human Services. The prevalence of anal cancer screening in these populations was estimated in the Chicago, Houston, and Milwaukee metropolitan areas which are in US regions with the highest anal cancer incidence among people with HIV (PWH).
Survey responses collected in 2020-2022 from individuals in the Prevent Anal Cancer studies were analyzed. The prevalence of anal cytology within the prior year and any history of high-resolution anoscopy (HRA) was stratified by HIV status in individuals of screening age (≥ 35 years for people with HIV and ≥ 45 years if HIV-negative). Factors associated with cytology and HRA were assessed using logistic regression. Barriers to anal cancer screening were assessed and stratified by HIV status.
A total of 540 individuals were of screening age and reported HIV status and anal cytology screening within the prior year. Most participants (84.4%, 456/540) were aged 45 years or older, and 52.0% (281/540) reported having HIV. The prevalence of anal cytology in the prior year was 8.3% (45/540) and did not differ by HIV status. Only a history of anal warts was associated with cytology (adjusted odds ratio, aOR 2.57, 95% CI 1.31-5.06). A history of undergoing HRA among PWH differed by metropolitan area: 35.9% (28/78) in Chicago, 18.1% (27/149) in Houston, and 20.8% (11/53) in Milwaukee (p = 0.001). PWH had more than double the odds of reporting a history of HRA (aOR 2.36, 95% CI 1.32-4.22) than HIV-negative people.
Among communities highly vulnerable to anal cancer, screening uptake was low and differed by metropolitan area. Interventions are urgently needed at clinical, provider, and individual levels to increase uptake.
NCT04090060 and NCT03489707.
Survey responses collected in 2020-2022 from individuals in the Prevent Anal Cancer studies were analyzed. The prevalence of anal cytology within the prior year and any history of high-resolution anoscopy (HRA) was stratified by HIV status in individuals of screening age (≥ 35 years for people with HIV and ≥ 45 years if HIV-negative). Factors associated with cytology and HRA were assessed using logistic regression. Barriers to anal cancer screening were assessed and stratified by HIV status.
A total of 540 individuals were of screening age and reported HIV status and anal cytology screening within the prior year. Most participants (84.4%, 456/540) were aged 45 years or older, and 52.0% (281/540) reported having HIV. The prevalence of anal cytology in the prior year was 8.3% (45/540) and did not differ by HIV status. Only a history of anal warts was associated with cytology (adjusted odds ratio, aOR 2.57, 95% CI 1.31-5.06). A history of undergoing HRA among PWH differed by metropolitan area: 35.9% (28/78) in Chicago, 18.1% (27/149) in Houston, and 20.8% (11/53) in Milwaukee (p = 0.001). PWH had more than double the odds of reporting a history of HRA (aOR 2.36, 95% CI 1.32-4.22) than HIV-negative people.
Among communities highly vulnerable to anal cancer, screening uptake was low and differed by metropolitan area. Interventions are urgently needed at clinical, provider, and individual levels to increase uptake.
NCT04090060 and NCT03489707.
Authors
Nyitray Nyitray, Walsh Walsh, Deshmukh Deshmukh, Chiao Chiao, Brzezinski Brzezinski, Ridolfi Ridolfi, Lundeen Lundeen, Nitkowski Nitkowski, Hazra Hazra
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