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Factors associated with anal cancer screening follow-up by high-resolution anoscopy
  1. Kaan Z Apaydin1,
  2. Andy Nguyen2,
  3. Christina P C Borba3,4,
  4. Derri L Shtasel2,5,
  5. Sharon Ulery1,
  6. Kenneth H Mayer1,2,
  7. Alex S Keuroghlian1,2,5
  1. 1 Fenway Health, The Fenway Institute, Boston, Massachusetts, USA
  2. 2 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
  4. 4 Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5 Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Alex S Keuroghlian, Fenway Health, The Fenway Institute, Boston, MA 02215, USA; akeuroghlian{at}


Objectives High-resolution anoscopy (HRA) is a potential screening method for detection of anal cancer precursors. We evaluated factors associated with adherence to recommended HRA follow-up time intervals among men who have sex with men (MSM).

Methods We employed a retrospective, observational cohort study with 155 MSM screened by HRA between 1 April 2011 and 31 March 2016 at a Federally Qualified Health Centre in Boston, Massachusetts.

Results The sample was 80% white, with a median age of 48 (non-normal distribution, IQR 15). All patients were assigned male sex at birth and none identified as transgender. Fifty patients (32%) followed up with a HRA appointment within 6 months of previous HRA detection of anal high-grade squamous intraepithelial lesion (HSIL). Among patients, 112 (72%) were HIV infected, 56 (36%) had a syphilis diagnosis during the study period, 89 (57.4%) had initiated Hepatitis A or B vaccination series, 70 (45.2%) accessed case management services and 19 (12.3%) utilised pre-exposure prophylaxis (PrEP). In bivariate analysis, patients who underwent recommended follow-up HRA within 6 months of HSIL diagnosis were less likely to report: case management utilisation (p=0.023), initiation of Hepatitis A or B vaccination (p=0.047), HIV diagnosis (p<0.001) and syphilis diagnosis (p=0.001), but were more likely to use HIV PrEP (p<0.001). In binomial logistic regression modelling after adjusting for age and race/ethnicity, patients who had follow-up with HRA within a recommended period of 6 months after HSIL diagnosis were less likely to have initiated Hepatitis A or B vaccination (adjusted OR 0.43, 95% CI 0.20 to 0.94), more likely to use PrEP (adjusted OR 4.47, 95% CI 1.30 to 15.49) and less likely to have a syphilis diagnosis (adjusted OR 0.34, 95% CI 0.14 to 0.86).

Conclusions Three-quarters of patients with HSIL did not have follow-up HRA within the clinic’s recommended follow-up period of 6 months following HSIL diagnosis by HRA. Future studies ought to explore whether addressing anal health during other STI-related care helps improve adherence to recommended time intervals for follow-up HRA. Given the high prevalence of STI and PrEP use, studies might also evaluate whether integrating HRA follow-up with other sexual health screenings helps improve adherence to recommended HRA follow-up.

  • anogenital cancer
  • gay men
  • Hiv
  • Hpv
  • screening

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  • Handling editor Nigel Field

  • Contributors KZA, DLS and ASK designed the study. KZA, CPCB, SU and ASK extracted the data and contributed to the analyses. All authors contributed to the drafting of the manuscript and approved the final version of it.

  • Funding This project was funded through a grant awarded to ASK by the Trefler Practitioner Program for Cancer Equity at the Kraft Center for Community Health Leadership and a K01MH100428 grant awarded to CPCB by NIMH.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Fenway Health Institutional Review Board, 885176.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. The second author’s first name is Andy and not Andrew as stated in the first version.