Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA.
Department of Dermatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Eur Acad Dermatol Venereol. 2021 Aug;35(8):1622-1627. doi: 10.1111/jdv.17263. Epub 2021 Jun 11.
The incidence of and mortality from anal cancer, predominantly squamous cell carcinoma (SCC), have been increasing since the 1980s, during an era when many common malignancies have seen decreases in mortality. Dermatologists may be more likely to see patients at an increased risk for anal SCC, such as those living with HIV, MSM and those presenting for management of anogenital warts, yet there is little guidance in the field on how to manage these patients. We underwent a project to review the evidence surrounding screening and prevention of anal SCC. HPV vaccination, the main preventative measure for anal SCC, is often underutilized and may not be effective for those most at risk. Screening methods currently include high-risk HPV and anal cytology testing, with high-resolution anoscopy (HRA) reserved for biopsy and confirmatory testing. High-risk HPV testing has been associated with high sensitivity for intraepithelial neoplasia, but low specificity in high-risk groups. Recent meta-analyses examining AIN detection using anal cytology estimate a similarly high sensitivity of 74-87%, with a relatively higher specificity (44-66%) for identifying high-grade AIN. HRA is the gold standard for diagnosis, but its accessibility and cost are deterrents from its use as a screening tool. Cervical cancer screening, initially adopted without significant evidence of its impact, has significantly decreased cervical cancer rates. The argument can be made that rates of anal SCC may also benefit from appropriate screening methods, particularly anal cytology. It is prudent for dermatologists to be aware of the methods available to them in the management of at-risk patients, the data supporting them, and the potential benefits of screening in order to counsel patients appropriately and address the increasing burden of disease.
自 20 世纪 80 年代以来，肛门癌（主要为鳞状细胞癌[SCC]）的发病率和死亡率一直在上升，而在这一时期，许多常见的恶性肿瘤的死亡率都有所下降。皮肤科医生可能更有可能看到患有肛门 SCC 风险增加的患者，例如那些感染 HIV、男男性行为者（MSM）以及那些因肛门生殖器疣就诊的患者，但在该领域，关于如何管理这些患者的指导很少。我们进行了一个项目，以回顾有关肛门 SCC 筛查和预防的证据。HPV 疫苗接种是预防肛门 SCC 的主要措施，但使用率较低，对于高危人群可能效果不佳。目前的筛查方法包括高危型 HPV 和肛门细胞学检测，高分辨率肛门镜检查（HRA）用于活检和确诊检测。高危型 HPV 检测与上皮内瘤变的高敏感性相关，但在高危人群中的特异性较低。最近的荟萃分析检查了使用肛门细胞学检测发现AIN 的情况，估计AIN 的检测敏感性为 74-87%，对于识别高级别 AIN 的特异性相对较高（44-66%）。HRA 是诊断的金标准，但由于其可及性和成本问题，限制了其作为筛查工具的使用。宫颈癌筛查最初是在没有其影响的大量证据的情况下采用的，但显著降低了宫颈癌的发病率。可以认为，通过适当的筛查方法，特别是肛门细胞学检测，肛门 SCC 的发病率也可能受益。皮肤科医生了解针对高危患者的管理方法、支持这些方法的数据以及筛查的潜在益处是谨慎的，以便能够适当地为患者提供咨询，并解决疾病负担不断增加的问题。
