Is There a Proven Link Between Anal Cancer Screening and Reduced Morbidity or Mortality?
Authors: Kenneth A. Katz, Christina A. Clarke, Kyle T. Bernstein, Mitchell H. Katz, Jeffrey D. Klausner
Journal: Annals of Internal Medicine (2009)

Letters17 February 2009Is There a Proven Link Between Anal Cancer Screening and Reduced Morbidity or Mortality?Kenneth A. Katz, MD, MSc, MSCE, Christina A. Clarke, PhD, MPH, Kyle T. Bernstein, PhD, ScM, Mitchell H. Katz, MD, and Jeffrey D. Klausner, MD, MPHKenneth A. Katz, MD, MSc, MSCEFrom Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103.Search for more papers by this author, Christina A. Clarke, PhD, MPHFrom Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103.Search for more papers by this author, Kyle T. Bernstein, PhD, ScMFrom Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103.Search for more papers by this author, Mitchell H. Katz, MDFrom Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103.Search for more papers by this author, and Jeffrey D. Klausner, MD, MPHFrom Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-4-200902170-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read with interest the study by Chin-Hong and colleagues (1) comparing techniques to detect anal intraepithelial neoplasia (AIN) among men who have sex with men. A more pressing question is whether sufficient evidence of effectiveness, in terms of reducing anal cancer morbidity or mortality, exists to support anal cancer screening. It does not.No prospective studies, including randomized, controlled trials, have assessed the effectiveness of anal cancer screening (2). Instead, screening proponents have cited indirect evidence, including analogy to cervical cancer screening, to advocate for routine screening among certain populations, such as men who have sex ...References1. Chin-Hong PV, Berry JM, Cheng SC, Catania JA, Da Costa M, Darragh TM, et al. Comparison of patient- and clinician-collected anal cytology samples to screen for human papillomavirus-associated anal intraepithelial neoplasia in men who have sex with men. Ann Intern Med. 2008;149:300-6. [PMID: 18765699] LinkGoogle Scholar2. Chiao EY, Giordano TP, Palefsky JM, Tyring S, El Serag H. Screening HIV-infected individuals for anal cancer precursor lesions: a systematic review. Clin Infect Dis. 2006;43:223-33. [PMID: 16779751] CrossrefMedlineGoogle Scholar3. Palefsky J, Hecht J, Riggs J, Scarce M. Needed: routine HPV vaccines and Pap smears for gay and bisexual men. The San Francisco Chronicle. 2007;Apr 24:B7. Google Scholar4. California Department of Public Health, Cancer Surveillance and Research Branch. California cancer registry. SEER*stat database: incidence—California, April 2008 (1988–2006). NCHS population estimates for 1990–2006; Benchmarked 1988–1989 DOF population estimates July 2007. Accessed at www.ccrcal.org on 7 January 2008. Google Scholar5. Pineda CE, Berry JM, Jay N, Palefsky JM, Welton ML. High-resolution anoscopy targeted surgical destruction of anal high-grade squamous intraepithelial lesions: a ten-year experience. Dis Colon Rectum. 2008;51:829-35; discussion 835-7. [PMID: 18363070] Google Scholar Author, Article, and Disclosure InformationAffiliations: From Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103.Note: The cancer incidence data used in this study were supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N01-PC-54404 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement 1U58DP00807-01 awarded to the Public Health Institute. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the State of California, the California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors. Endorsement by any of those agencies is not intended nor should be inferred.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison of Patient- and Clinician-Collected Anal Cytology Samples to Screen for Human Papillomavirus–Associated Anal Intraepithelial Neoplasia in Men Who Have Sex with Men Peter V. Chin-Hong , J. Michael Berry , Su-Chun Cheng , Joseph A. Catania , Maria Da Costa , Teresa M. Darragh , Fred Fishman , Naomi Jay , Lance M. Pollack , and Joel M. Palefsky Is There a Proven Link Between Anal Cancer Screening and Reduced Morbidity or Mortality? Peter V. Chin-Hong , Nancy A. Hessol , and Joel M. Palefsky Metrics Cited ByShared decision-making around anal cancer screening among black bisexual and gay men in the USAThe Need for Outcome Studies Prior to Large-Scale Implementation of Screening for Anal CancerNeoplasms in Acquired Immunodeficiency SyndromeDeterminants of macroscopic anal cancer and precancerous lesions in 1206 HIV-infected screened patientsHPV and Anal Cancer in HIV-Infected Individuals: A ReviewTrends in the occurrence of high-grade anal intraepithelial neoplasia in San Francisco: 2000-2009Impact of the HIV Epidemic on the Incidence Rates of Anal Cancer in the United StatesThe reporting of anal cytology and histology samples: establishing terminology and criteriaWE NEED DATA ON ANAL SCREENING EFFECTIVENESS BEFORE FOCUSING ON INCREASING ITAnal carcinoma in human immunodeficiency virus-positive men: results of a prospective study from Germany 17 February 2009Volume 150, Issue 4Page: 283-284KeywordsAnal cancerCancer epidemiologyCancer preventionCancer screeningHistologyPopulation statisticsPrevention, policy, and public healthSquamous cell carcinoma ePublished: 17 February 2009 Issue Published: 17 February 2009 CopyrightCopyright © 2009 by American College of Physicians. 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