Abstract
Barriers to anal dyplasia screening are numerous and multifactorial. It is a rare
disease, comprising only 2.5% of all gastrointestinal malignancies. Of the populations
at high risk, men who have sex with other men (MSM), especially those living with
HIV, represent the most studied high-risk population. Although knowledge of human
papillomavirus (HPV) is relatively high in this population, its link to anal cancer
and self-perception of risk of anal cancer in this population remains low. There are
little, if any, data on provider knowledge or awareness of anal dysplasia or the high-risk
populations that would benefit from screening. Given the recent advent of comprehensive
anal cancer screening guidelines by the International Anal Neoplasia Society, this
gap in knowledge is not suprising. Even among providers aware of these guidelines,
other barriers exist, including possible discomfort discussing anal health, sexual
practices, or discomfort in the performance of the screening test. Providers may also
face challenges interpreting results of screening tests or finding specialists in
high-resolution anoscopy for referral in the instance of a positive screening test.
Finally, MSM and persons living with HIV have historically experienced stigmatization
within the health care system. These historical underpinnings further complicate efforts
to implement screening programs in these populations.
Keywords
cancer screening - implementation science - anal dysplasia - LGBT health - sexual
and gender minority cancer
