BMJ  2006;332:237 (28 January), doi:10.1136/bmj.332.7535.237-a

Letter

When to test women for human papillomavirus

Take this opportunity to screen for anal cancer too

Editor—The impact of screening for human papillomavirus (HPV) on the rates of cervical intraepithelial neoplasia is topical.¹ The introduction of routine cytological screening has reduced the incidence of cervical cancer.

Despite obvious similarities, anal cancer has not been given the same level of attention. There are no guidelines regarding screening. The incidence of anal cancer has increased by almost 40% in women.² A 26% genotypic concordance exists among concurrent HPV infections of the cervical and anal canals, indicating a common source of infection, such as vaginal and anal intercourse with the same infected partner(s).³ Women with cervical infection have three times the risk of anal infection, and up to 13% will be infected at both sites.³ In the anus, however, non-oncogenic strains predominate. This may explain the lower prevalence of anal compared with cervical cancers.

This, however, does not detract from the fact that young healthy women, infected with HPV 16 and 18, with a regular consumption of alcohol, a history of chlamydial infection, early age of sexual intercourse, and several lifetime sexual partners are at risk of cervical infection.³

These may be the risk factors that point to anal cancer. HIV infection and immunosuppression further increase this risk.² It may be prudent to use these in establishing guidelines for anal cancer screening, particularly with the growing indication that the two entities may share a common aetiology.

University of Michigan Health Systems jhayanga{at}med.umich.edu

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Competing interests: None declared.

References

1. Legood R, Gray A, Wolstenholme J, Moss S. Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: modelling study. BMJ 2006;332: 79-85. (14 January.)[Abstract/Free Full Text]
2. Chang GJ, Berry M, Jay N, Palefsky, JM, Welton ML. Surgical treatment of high-grade anal squamous intraepithelial lesions: a prospective study. Dis Colon Rectum 2002 Apr;45(4): 453-8[CrossRef][ISI][Medline]
3. Hernandez B, McDuffie K, Zhu X, Wilkens LR, Killeen J, Kesse B, et al. Anal human papillomavirus infection in women and its relationship with cervical infection. Cancer Epidemiol Biomarkers Prev 2005;14(11 Pt 1): 2550-6.[Abstract/Free Full Text]

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Relevant Article

Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: results of the NHS pilot studies

Rosa Legood, Alastair Gray, Jane Wolstenholme, and Sue Moss
BMJ 2006 332: 79-85. [Abstract] [Full Text] [PDF]