The fear factor: drivers and barriers to follow-up screening for human papillomavirus-related anal cancer in men who have sex with men

• Published in: International journal of STD & AIDS 2010-07, Vol.21 (7), p.482-488
• Main Authors: Truesdale, M D, Goldstone, S E
• Format: Article
• Language: English
• Subjects: Adult; AIDS/HIV; Anus Neoplasms - diagnosis; Anus Neoplasms - psychology; Biological and medical sciences; Early Detection of Cancer - psychology; Epidemiology. Vaccinations; Fear; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Homosexuality, Male; Human papillomavirus; Humans; Infectious diseases; Interviews as Topic; Male; Medical sciences; Middle Aged; Papillomaviridae - isolation & purification; Papillomavirus Infections - diagnosis; Patient Compliance - statistics & numerical data; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surveys and Questionnaires; Tumors
• ISSN: 0956-4624; 1758-1052
• DOI: 10.1258/ijsa.2010.010070

Human papillomavirus (HPV)-related anal cancer incidence is rising in men who have sex with men (MSM). Effective screening strategies exist, but many patients are lost to follow-up (LTF). We studied factors impacting screening compliance to recommended annual screening visits. Retrospective chart review identified MSM with anal dysplasia. MSM were grouped as regular screeners (regular to follow-up [RF]) (≥1 visit/year), lost to follow-up (LTF) (>1 year since previous screening) and LTF who then returned for screening (lost came back [LCB]). From June 2007 to March 2008, subjects completed a questionnaire in-person at the time of screening or via telephone (LTF). Questionnaires were completed after anal dysplasia diagnosis. One hundred and ninety-five MSM were enrolled (96 RF, 50 LTF and 49 LCB). RF were compliant for 4.8 years; LTF were lost for 2.3 years. LCB were previously lost for 5.6 years before returning. Mean knowledge score of screening procedures was larger in RF versus LTF (P < 0.001). MSM with more sexual partners in the past six months were more likely to be LCB versus LTF (P = 0.05). RF were more likely to describe their HPV diagnosis as ‘upsetting’ (P = 0.003). RF were more likely driven by physical symptoms versus LTF (P = 0.002). MSM with high-grade intraepithelial lesions (HSIL) were more likely to be RF versus those with low-grade intraepithelial lesions (P = 0.001. Positive predictors for screening compliance include an upsetting experience during the HPV diagnosis, physical symptoms driving the initial visit and HSIL. Engaging patients in a firm, salient approach may facilitate follow-up compliance.