{"id":46657,"date":"2024-06-07T12:00:00","date_gmt":"2024-06-07T12:00:00","guid":{"rendered":"https:\/\/www.cancer.gov\/news-events\/cancer-currents-blog\/2024\/anal-cancer-screening-self-collected"},"modified":"2024-11-03T15:11:50","modified_gmt":"2024-11-03T15:11:50","slug":"anal-cancer-advances-open-door-to-screening-and-prevention","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/anal-cancer-advances-open-door-to-screening-and-prevention\/","title":{"rendered":"Anal Cancer Advances Open Door to Screening and Prevention"},"content":{"rendered":"

\n
\n
\"Gloved <\/div>
\n
\n

Researchers are studying different approaches for anal cancer screening, including one that allows people to self-collect samples for testing.<\/p>\n

Credit: iStock\/fernando novoa<\/p>\n<\/p><\/div>\n<\/figcaption><\/figure>\n<\/p><\/div>\n

When Daniel G. Garza was diagnosed with anal cancer a decade ago, he had never heard of the disease. \u201cDo you mean colorectal cancer?\u201d he asked the doctor.
 
The doctor explained that Garza had a tumor on his anal sphincter<\/a>. At the time, Garza had been living with HIV<\/a> for 14 years. But he did not know that gay and bisexual men, especially those with HIV, have an increased risk of anal cancer.
 
\u201cI had never talked about anal cancer with a doctor or with the gay men I knew,\u201d said Garza, who lives in California. \u201cNo one ever said to me, \u2018Hey, you should be aware that you have an increased risk of this cancer.\u2019\u201d
 
Garza\u2019s unfamiliarity with anal cancer is perhaps not surprising. Many gay and bisexual men do not have basic information about the disease<\/a>, studies have shown. <\/p>\n

Since completing his cancer treatment, Garza has been trying to raise awareness of anal cancer, particularly among Latino and Hispanic communities. In the process, he has learned about research advances that could eventually help reduce the disease’s growing burden<\/a>. <\/p>\n

For example, in 2022 a large NCI-sponsored randomized clinical trial<\/a> demonstrated that detecting and treating precancerous<\/a> growths in the anus substantially reduced a person\u2019s risk of developing anal cancer<\/a>. The study, called ANCHOR, included people with HIV aged 35 or older. <\/p>\n

\u201cThe ANCHOR trial demonstrated that we can prevent this disease,\u201d said Megan Clarke, Ph.D., of NCI\u2019s Division of Cancer Epidemiology and Genetics (DCEG)<\/a>, who studies anal cancer and was not involved in the trial.<\/p>\n

Dr. Clarke cautioned, however, that continued progress will depend on overcoming certain challenges, such as a shortage of health care providers trained in performing high-resolution anoscopy<\/a> to detect and treat precancerous anal lesions.<\/p>\n

Now that scientists know treating precancerous lesions can prevent anal cancer, more research is needed to determine the best ways to screen people for anal precancerous lesions. This work is under way. For instance, some investigators have been exploring strategies for conducting anal cancer screening in ways that reduce barriers to participation<\/a>.<\/p>\n

Such studies may help to generate the evidence needed to inform efforts to prevent anal cancer in the future, Dr. Clarke noted.<\/p>\n

\u201cWe need to take the momentum generated by the ANCHOR results and use it to expand research on the disease,\u201d she said. \u201cFor those of us who study screening, it\u2019s an exciting time.”<\/p>\n

What causes anal cancer?<\/h2>\n

In the general population, anal cancer is rare, but certain groups have an increased risk of the disease. The highest risk groups include people with HIV and men who have sex with men. Overall, however, more women develop anal cancer than men in the United States.<\/p>\n

Like most cervical cancers, nearly all anal cancers are caused by the persistent infection of anal cells with cancer-causing types of human papillomavirus (HPV<\/a>).<\/p>\n

If the immune system<\/a> does not eliminate the infected cells, these cells may form precancerous growths, called <\/span>high-grade<\/a> <\/span>squamous intraepithelial lesions<\/a>, that can lead to cancer if left untreated.<\/span><\/p>\n

Although HPV vaccines were initially developed to prevent cervical cancer, the vaccines also help protect against other HPV-related cancers, including anal cancer. Gardasil<\/a>, for instance, has been approved for anal cancer prevention.<\/p>\n

New guidelines on screening for anal cancer<\/h2>\n

When the ANCHOR results were published, Robert Yarchoan, M.D., director of NCI\u2019s Office of HIV and AIDS Malignancy<\/a>, said the findings for the first time provided a strong rationale for screening people with HIV for the presence of precancerous anal lesions.<\/p>\n

For decades, clinics in places like New York and San Francisco have screened people in at-risk groups for anal cancer. But until recently there were no overarching expert-reviewed national or international guidelines for anal cancer screening.<\/p>\n

That changed in March 2024, when an international group of experts representing the International Anal Neoplasia Society released consensus guidelines on anal cancer screening<\/a>. Because the disease is rare in the general population, the guidelines focus on screening individuals who have an increased risk of the disease.<\/p>\n

For instance, these guidelines recommend that anal cancer screening start at age 35 for some people who are living with HIV, particularly men who have sex with men and transgender<\/a> women. For other people with HIV and for men who have sex with men and transgender women who are not living with HIV, they recommend starting screening at age 45.<\/p>\n

\u201cThe ANCHOR trial provided additional momentum for us to publish the guidelines,\u201d said Dr. Clarke, who served on the task force that created the recommendations.<\/p>\n

The Prevent Anal Cancer Self-Swab Study<\/h2>\n

Even before the guidelines were published, researchers at the Medical College of Wisconsin, in Milwaukee, had been testing a home-based approach to anal cancer screening. In this approach, a person collects their own cells (self-swabs) and sends the sample to a laboratory for analysis.<\/p>\n

The strategy was based in part on self-collection techniques that have shown promise in cervical cancer<\/a>. The Food and Drug Administration has just approved two kits used for self-collection of vaginal samples for HPV testing.<\/p>\n