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. 2025 Jan 9;17(2):193.
doi: 10.3390/cancers17020193.

Anal Cancer Screening: 10-Year Experience of a Specialized Outpatient Clinic

Iolanda Espirito Santo  1   2 , Amaniel Kefleyesus  1   2 , Camille Chilou  1   2 , Seraina Faes  1   2   3 , Daniel Clerc  1   2   4 , Martin Hübner  1   2 , Dieter Hahnloser  1   2 , Fabian Grass  1   2
Affiliations

Anal Cancer Screening: 10-Year Experience of a Specialized Outpatient Clinic

Iolanda Espirito Santo et al. Cancers (Basel). .

Abstract

In 2012, the Department of Visceral Surgery of the Lausanne University Hospital CHUV implemented a dedicated high-resolution anoscopy (HRA) outpatient clinic for surveillance and follow-up purposes. This 10-year longitudinal study analyzed 537 patients (2214 visits) using a structured screening protocol. Dysplastic lesions were detected in 49% of patients, predominantly low-grade squamous intraepithelial lesions (LSILs, 74%). Among LSIL cases, 6% progressed to high-grade squamous intraepithelial lesions (HSILs) within 24 months, reaching 25% cumulative progression at 36 months. Of HSIL patients, 3% developed carcinoma in situ after 48 months. Notably, no invasive carcinoma was observed during the follow-up. Four patients diagnosed with squamous cell carcinoma at initial screening were treated with chemoradiotherapy, and one required salvage surgery. Independent risk factors for the presence of higher-stage precancerous lesions (≥HSILs) were the presence of high-risk HPV genotypes (OR 14.5, 95% CI 5-42.2, p < 0.001), detectable HIV viral load (OR 5.4, 95% CI 1.8-16.7, p = 0.003), and symptoms at the first screening visit (OR 3.2, 95% CI 1.1-9.9, p = 0.04). HIV-positive status was associated with a trend towards an increased risk of progression (OR 2.79, p = 0.073). These findings highlight the importance of systematic follow-up and early intervention in high-risk populations to prevent anal cancer progression.

Keywords: HIV; HPV testing; MSM; algorithm; anal cancer; anal dysplasia; high-resolution anoscopy; screening.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Patient referrals to the institutional HRA clinic. HRA—high-resolution anoscopy. Others include referring surgeons and local emergency departments.
Figure 2
Figure 2
Multinominal logistic regression analysis of risk factors for higher-stage lesions (≥HSILs). Displayed are odds ratios (black squares) with 95% confidence intervals (black bars). Two error bars are clipped at the axis limit. Charlson—Charlson Comorbidity Index, MSM—men who have sex with men, HIV—human immunodeficiency virus, HR-HPV—presence of high-risk human papillomavirus genotypes.
Figure 3
Figure 3
Histopathological findings during the first screening visit and progression rates during follow-up. LSIL—low-grade squamous intraepithelial lesion; HSIL—high-grade squamous intraepithelial lesion.
Figure 4
Figure 4
Cumulative risk of disease progression from LSIL to HSIL (red) and from HSIL to carcinoma in situ (green). LSIL—low-grade squamous intraepithelial lesion; HSIL—high-grade squamous intraepithelial lesion.
Figure 5
Figure 5
Institutional algorithm for HRA follow-up and treatment. HRA—high-resolution anoscopy, HPV—human papillomavirus, HIV—human immunodeficiency virus, HSIL—high-grade squamous intraepithelial lesion, LSIL—low-grade squamous intraepithelial lesion.
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