“Other” high‐risk HPV: Challenges in anal cancer screening
Abstract
and faced barriers in health care access, there are many questions about how to optimize public health strategies to address this increasingly common malignancy. Although cytology by itself is limited by low sensitivity, the addition of hrHPV testing creates challenges in specificity, particularly because a growing body of evidence shows that triage to HRA based on HPV16 positivity may not be appropriate for all populations due to prevalence of other non - 16/ non - 18 hrHPV in certain groups. Furthermore, exceedingly high rates of HSIL or carcinoma ranging from 22% 6 up to 41% 7 in some high - risk cohorts raise the question of whether individuals at highest risk should be routinely assessed by screening or should just proceed directly to HRA, which, despite being more invasive and costly, would allow for simultaneous treatment of lesions of concern. Additional areas for study include further assessment of non - 16/non - 18 hrHPV subtypes in various populations and whether vaccination provides adequate coverage. Furthermore, the value of other potential tools for triage that have been deployed in cervical cancer screening, such as dual p16/Ki - 67 immunostaining, have yet to be fully assessed in the context of anal cytology. To address the growing burden of morbidity and mortality associated with anal cancer, additional study is needed; however, any such studies must evaluate a diverse patient population that is fully representative of those who are most at risk for anal…
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