Screening for intra‐anal squamous intra‐epithelial lesions in women with a history of human papillomavirus‐related vulvar or perianal disease: results of a screening protocol

• Published in: Colorectal disease 2020-12, Vol.22 (12), p.1991-1998
• Main Authors: Leber, K., Beurden, M., Zijlmans, H. J., Dewit, L., Richel, O., Vrouenraets, S. M. E.
• Format: Article
• Language: English
• Subjects: anal cancer; Anus; Cancer; Cervix; Colorectal cancer; high resolution anoscopy; Human papillomavirus; Invasiveness; Lesions; screening; Squamous cell carcinoma; Vagina; women
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.15320

Aim Women with a history of human papillomavirus (HPV)‐related cervical, vaginal or vulvar high‐grade squamous intra‐epithelial lesions (HSILs) or cancer are at increased risk of developing anal squamous intra‐epithelial lesions (SILs) or a squamous cell carcinoma of the anus (SCCA). Screening for intra‐anal SILs with high‐resolution anoscopy (HRA) in high‐risk populations is a subject of debate. In this study we aimed to answer the following question: what is the prevalence of intra‐anal (H)SIL in women with HPV‐related vulvar and/or perianal disease using HRA for screening? Method A retrospective study was performed to evaluate the prevalence of intra‐anal (H)SIL in women with a history of vulvar and/or perianal HSIL or (superficially invasive) squamous cell carcinoma (SCC). This study was performed between 2015 and 2018 following implementation of a protocol for intra‐anal screening using HRA. Results Twenty‐seven patients, 10 with a history of (superficially invasive) SCC (four vulvar, five perianal, one multizonal) and 17 with HSIL as the worst diagnosis (two perianal, 15 multizonal) were screened for intra‐anal lesions using HRA. No anal cancer was found at screening, 6 (22%) patients were diagnosed with intra‐anal HSIL and 12 (44%) patients with intra‐anal low‐grade SIL. Conclusions We found a high prevalence of intra‐anal HSIL in women previously diagnosed with vulvar and perianal HSIL. Given the clear link between HSIL and SCCA, screening for intra‐anal lesions in women with HPV‐related genital pathology seems warranted. Future studies should focus on the effect of HSIL treatment on the prevention of anal cancer.