The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus HPV and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions HSIL. Our goal was to summarize the literature on anal cancer, HSIL and HPV infection in women, and provide screening recommendations in women. Anal HPV infection is common in women but is relatively transient in most.
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There is still much to be learnt about the best form of screening for anal cancer, and there are currently no widely accepted clinical guidelines for doctors on anal screening. At the moment, there is insufficient understanding of how anal cancer progresses from the early stages, which lesions are most likely to develop, and which treatments are most effective. Research projects are being conducted in Australia now to see what these guidelines might be. See below. However many clinicians believe early detection through anal screening is the right approach. What is clear is that there are advantages in people knowing that they have early signs of anal changes — which may or may not progress — and to ask their doctor to keep monitoring for changes in the anus.
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The prevalence of anal intraepithelial neoplasia has been increasing, especially in high-risk patients, including men who have sex with men, human immunodeficiency virus positive patients, and those who are immunosuppressed. This number is considerably higher for those at high risk. Anal cytology has been used to attempt to screen high-risk patients for disease; however, it has been shown to have very little correlation to actual histology. Patients with lesions should undergo history and physical exam including digital rectal exam and standard anoscopy. High-resolution anoscopy can be considered as well, although it is of questionable time and cost—effectiveness.
Many anal cancers can be found early. Early anal cancers often have signs and symptoms that lead people to see a doctor. Unfortunately, some anal cancers may not cause symptoms until they reach an advanced stage.