Longitudinal Testing of Anal Cytology and Human Papillomavirus in Females With Lower Genital Tract Dysplasia or Cancer

Objective This study aimed to determine the prevalence of anal dysplasia in women who had anal high-risk human papillomavirus (HR-HPV) and/or abnormal cytology in 2012–2014. Methods The authors performed a prospective cohort study evaluating females with a history of lower genital high-grade dysplasia or cancer who underwent HR-HPV anal testing and anal cytology between 2012 and 2014. Patients from this original cohort ( N = 190) were approached for rescreening with anal cytology and HR-HPV testing. Descriptive statistics and Fisher's exact test were performed. Results Forty-one patients were rescreened. Fourteen patients (34%) had abnormal results (abnormal cytology and/or positive HR-HPV) and were referred for high-resolution anoscopy. Eight underwent high-resolution anoscopy with the following 7 undergoing biopsies resulting as normal: 3, anal low-grade squamous intraepithelial lesion (AIN 1): 3, anal high-grade squamous intraepithelial lesion (AIN2/3): 1. Of the 27 (66%) patients with prior abnormal results in 2012–2014, 10 (37%) had persistent abnormal results. Four patients had newly abnormal screening results. Persistent HR-HPV infections were identified in 10%, new infections in 2%, and resolved infections in 22%. Nine patients (22%) followed up with colorectal since their initial 2012–2014 anal screening with 1–2 visits. Of those who followed up, 4 patients had persistent abnormal screening results including 1 with persistent HPV-16 and high-grade dysplasia. Conclusions Women in the cohort continued to display high rates of anal dysplasia and HR-HPV infection on 10-year follow-up anal screening. The data support long-term, regular anal screening in patients with a history of lower genital tract dysplasia or cancer to identify and treat anal dysplasia in this high-risk cohort.