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HHC Offers Specialized Screening for Anal Cancer

July 15, 2024

Cervical and oral cancers have gotten almost all of the attention in public-health conversations around the human papillomavirus (HPV). Amanda Ayers, MD, a Hartford HealthCare colon and rectal surgeon based in eastern Connecticut, wants to bring attention to the fact that HPV can cause anal cancer as well.

Anal dysplasia is a precancerous condition that occurs when cells in the anus or anal canal become abnormal. These abnormal cells can develop into anal cancer if left untreated or not monitored.

Anal dysplasia is almost always caused by HPV. Those considered at risk are men who have sex with men, transgender women, or anyone living with HIV, people who have had a solid organ transplant (like liver or kidney) or persons with a history of vulvar cancer or dysplasia.

Dr. Ayers says the study of anal dysplasia “is a rapidly evolving field. It’s really only in the last 10 or 15 years that we’ve developed an understanding of what it is.”

Once HPV is introduced into the human body “it stays there forever,” she explains. “Some bodies are able to fight it, others are not. Those who are immuno-suppressed, like those living with HIV, or those who have had a solid organ transplant such as kidney or liver – with them, these cells are more likely to progress to cancer.”

Screening for anal dysplasia – finding those abnormal cells early, before they have the chance to become cancerous, “reduces the progression to developing anal cancer by 57 percent,” Dr. Ayers says. Screenings for at-risk patients is important because anal dysplasia typically has no symptoms.

Screening is done with a high-resolution anoscopy (HRA). The doctor inserts a small plastic tube that allows a special microscope called a colposcope to view the anus. If suspicious lesions are found, a small tissue sample is taken and sent to a pathologist.

If anal dysplasia is detected, the patient is monitored and has regular rectal exams. This can include an anal pap smear, which is similar to a Pap smear for the cervix. The doctor inserts a cotton swab into the anus to collect cells, which are examined by a pathologist for signs of precancerous or cancerous changes.

Immediate treatment of the abnormal cells includes fulguration, a procedure that uses heat from an electric current to destroy the abnormal tissue. “It’s very targeted,” Ayers says. “We don’t excise it because we don’t want scar tissue in that area.”

Ayers does the procedure at Backus Hospital in Norwich. She said her team is working with community partners who are connected to at-risk groups in the area to spread the word about what anal dysplasia is, the availability of screening and the risks of anal cancer.

“This is a relatively simple thing that can make a big difference overall in the health of those in these high risk groups,” she says. “They need attention and treatment to prevent cancer, and they can be marginalized when it comes to medical care. It’s important for them to be seen and cared for.”