Anal cancer screening: Techniques and guidelines

Anal squamous cell cancer has a precancerous stage of high-grade squamous intraepithelial lesion (HSIL). Some centers still use the terminology of anal intraepithelial neoplasia (AIN) where HSIL covers AIN2 and AIN3. Techniques that may be used for screening to prevent anal cancer aim to detect HSIL with high sensitivity and specificity and relatively low cost. Cytology and human papillomavirus detection are currently available; however, both have insufficient sensitivity and specificity to be reliable screening techniques, especially in the highest-risk groups for anal cancer. Biomarker tests are under consideration. High resolution anoscopy (HRA) is the gold standard for detecting anal precancer lesions; however, it is expensive and labor-intensive. For these reasons, there is a lack of national screening strategies for anal cancer. Guidelines quickly become out of date in this rapidly changing field: the German-Austrian 2015 guidelines are the most current.