Anal Cancer Screening and Prevention

1. Guidelines for Screening

Risk Factors

Human papilloma virus: (HPV-16, HPV 18, HPV 31, HPV 33, and HPV 45) accounts for about 85 - 90% of anal cancers

Sexual activity: Multiple sex partners, particularly uncircumcised men, increase the risk of exposure to HPV due to the increased risk of exposure to the HPV virus by 17 fold, if their partners are infected with the HPV virus

Smoking: Current smokers have a fourfold increase in risk of developing anal cancer

Immunosuppression: This is often associated with HIV infection or transplantation

Benign anal lesions (inflammatory bowel disease, hemorrhoids or fistula) 

Anal intraepithelial neoplasia



Anal PAP smears (similar to those used in cervical cancer) for patients with risk factors. The test should be repeated yearly in

HIV-positive men who have sex with men, and every 2 - 3 years if the men are HIV-negative

Patients with abnormal results should be referred for a biopsy. If anal intraepithelial neoplasia is detected, this condition should be referred for treatment


2. Cancer Prevention

Use of condoms

Vaccination with Gardisil® before exposure to HPV prevents infection by some strains of HPV and has been shown to reduce the incidence of potentially precancerous lesions at other sites (cervix)