You have full access to this open access article. Precursors to anal squamous cell carcinoma may be detectable through screening; however, the literature suggests that population-level testing is not cost-effective. Given that high-grade cervical neoplasia CIN is associated with an increased risk of developing anal cancer, and in light of changing guidelines for the follow-up and management of cervical neoplasia, it is worthwhile to examine the costs and effectiveness of an anal cancer screening program delivered to women with previously-detected CIN.
Costs were based on Canadian estimates, and survival was based on estimates taken from the scientific literature. The model was run for 50 cycles, with each cycle representing one year. Incremental cost screened vs. Incremental effectiveness was 0. Our analysis suggests that anal cancer screening is cost-effective in terms of overall survival in women with a previous diagnosis of CIN II or CIN III as part of regular follow-up, but may not contribute meaningfully-different quality-adjusted survival due to the adverse effects of screening-related interventions.
Squamous cell carcinoma SCC of the anal canal is a relatively rare cancer of the gastro-intestinal GI tract, representing approximately 1. In women it is well established that Cervical Intraepithelial Neoplasia CIN , often detected through cervical cancer screening, is linked to high-risk HPV subtypes and progression to invasive cervical cancer if left untreated [ 2 — 4 ] and multiple studies have shown that women with a past diagnosis of CIN or cervical cancer are also at increased risk of developing anal cancer [ 5 — 9 ].
Anal cancer screening strategies have predominantly been applied to high-risk populations, mainly HIV positive MSM, but the scientific literature is not clear on the cost-effectiveness of such programs. Goldie et al. Both teams concluded that no subgroup, be it men or women, status HIV positive or negative, stood to benefit from anal cancer screening [ 3 , 20 ].
Lazenby et al. Despite the lack of clear consensus in the medical literature, many jurisdictions such as clinics in San Francisco and Vancouver have adopted anal cancer screening programs for HIV positive MSM and are evaluating the possibility of widening indications for screening to other risk groups such as HIV negative MSM, and women at high risk such as HIV positive women and women with a history of cervical dysplasia.
