A guide for primary care providers
The role of Human Papilloma Virus (HPV) in the pathogenesis of cervical cancer has been well documented. Cervical cytology obtained through cervical PAP smear has been integrated into primary care as a routine screening device to find pre-cancerous lesions that can be addressed before they progress to invasive cancer. As a result, there has been a decrease in the incidence of cervical cancer from 35 per 100, 000 to 8 per 100, 000 in the United States [1]. From similar embryologic lineage, the anal canal appears also to be affected by HPV, with potentially similar outcomes. Though anal cancer is a rare tumor with incidence of 7-9 per 1,000,000 in the general population, the incidence increases in certain populations specifically men who have sex with men (MSM) with some sources quoting an incidence of anal cancer as high as 35 per 100, 000 [2]. This incidence may as much as double that in the HIV-positive population [3]. Identification of pre-cancerous lesions in these patients may lead to a reduction in anal cancer and its associated morbidity and mortality.
The question facing practitioners aware of this increased risk of anal cancer in the MSM population is the use of the anal pap to screen for this disease. Though circumstantial evidence indicates that the anal dysplasia that is found on the anal pap is a precursr to cancer, there is no model of the natural history of these lesions to cancer. This web site is devoted to educating the provider about what is the current state of the art regarding the anal pap. The ultimate decision to include this intervention in routine clinical practice depends on the provider.
A guide for primary care providers
