Acceptability of anal cancer screening tests for women living with HIV in the EVVA study

  • E. Kaufman McGill University, Cumming School of Medicine, University of Calgary
  • C. de Castro Chronic Viral Illness Service, McGill University Health Centre
  • T. Williamson Cumming School of Medicine, University of Calgary
  • B. Lessard Chronic Viral Illness Service, McGill University Health Centre
  • M. Munoz Chronic Viral Illness Service, McGill University Health Centre
  • M.H. Mayrand Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal
  • A. N. Burchell St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, CIHR Canadian HIV Trials Network
  • M. B. Klein Chronic Viral Illness Service, McGill University Health Centre (MUHC), CIHR Canadian HIV Trials Network
  • L. Charest Clinique Médicale L’Actuel
  • M. Auger McGill University and McGill University Health Centre (MUHC)
  • V. Marcus McGill University and McGill University Health Centre (MUHC)
  • F. Coutlée Chronic Viral Illness Service, McGill University Health Centre (MUHC) Centre Hospitalier de l’Université de Montréal (CHUM) and Université de Montréal
  • A. de Pokomandy McGill University, Chronic Viral Illness Service, McGill University Health Centre (MUHC), CIHR Canadian HIV Trials Network
  • EVVA Study Group
Keywords: hiv, human papillomavirus, hpv, women, anal cancer, screening acceptability, cancer prevention

Abstract

Background Anal cancer is potentially preventable through screening. For screening to be implemented, the screening procedures must be acceptable to the affected population. The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a population of women living with hiv who had experienced the tests.

Methods The evva study (“Evaluation of Human Immunodeficiency Virus, Human Papillomavirus, and Anal Intraepithelial Neoplasia in Women”) is a prospective cohort study of adult women living with hiv in Montreal, Quebec. Participants were screened with cervical or anal hpv testing and cervical or anal cytology every 6 months for 2 years. High-resolution anoscopy (hra) and digital anal rectal examination (dare) were also performed systematically, with biopsies, at baseline and at 2 years. An acceptability questionnaire was administered at the final visit or at study withdrawal.

Results Of 124 women who completed the acceptability questionnaire, most considered screening “an absolute necessity” in routine care for all women living with hiv [77%; 95% confidence interval (ci): 69% to 84%]. Yearly anal cytology or anal hpv testing was considered very acceptable by 81% (95% ci: 73% to 88%); hra every 2 years was considered very acceptable by 84% (95% ci: 77% to 90%); and yearly dare was considered very acceptable by 87% (95% ci: 79% to 92%). Acceptability increased to more than 95% with a longer proposed time interval. Pain was the main reason for lower acceptability.

Conclusions Most participating women considered anal cancer screening necessary and very acceptable. Longer screening intervals and adequate pain management could further increase the acceptability of repeated screening.

Author Biographies

E. Kaufman, McGill University, Cumming School of Medicine, University of Calgary
Department of Family Medicine
T. Williamson, Cumming School of Medicine, University of Calgary
Department of Community Health Sciences
M.H. Mayrand, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal
Département d’Obstétrique-Gynécologie et Médecine Sociale et Préventive
A. N. Burchell, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, CIHR Canadian HIV Trials Network
Department of Family and Community Medicine and Centre for Urban Health Solutions
M. Auger, McGill University and McGill University Health Centre (MUHC)
Department of Pathology
V. Marcus, McGill University and McGill University Health Centre (MUHC)
Department of Pathology
F. Coutlée, Chronic Viral Illness Service, McGill University Health Centre (MUHC) Centre Hospitalier de l’Université de Montréal (CHUM) and Université de Montréal
Département de Microbiologie et Infectiologie
A. de Pokomandy, McGill University, Chronic Viral Illness Service, McGill University Health Centre (MUHC), CIHR Canadian HIV Trials Network
Department of Family Medicine
Published
2020-03-06
How to Cite
Kaufman, E., de Castro, C., Williamson, T., Lessard, B., Munoz, M., Mayrand, M., Burchell, A. N., Klein, M. B., Charest, L., Auger, M., Marcus, V., Coutlée, F., de Pokomandy, A., & Study Group, E. (2020). Acceptability of anal cancer screening tests for women living with HIV in the EVVA study. Current Oncology, 27(1). https://doi.org/10.3747/co.27.5401
Section
Cancer Control and Prevention