TY - JOUR
T1 - Prevalence and predictors of unsatisfactory anal cytology tests in a cohort of gay and bisexual men in Sydney, Australia
T2 - baseline findings from the Study of the Prevention of Anal Cancer (SPANC)
AU - Templeton, David J.
AU - Roberts, Jennifer M.
AU - Poynten, I. Mary
AU - Law, Carmella
AU - Hillman, Richard J.
AU - Farnsworth, Annabelle
AU - Fairley, Christopher K.
AU - Tabrizi, Sepehr N.
AU - Garland, Suzanne M.
AU - Grulich, Andrew E.
AU - Jin, Fengyi
AU - Acraman, Brian
AU - Carr, Andrew
AU - Carroll, Susan
AU - Cooper, David
AU - Cornall, Alyssa
AU - Crampton, Leonie
AU - Fairley, Kit
AU - Feeney, Lance
AU - Fraissard, Eddie
AU - Howard, Kirsten
AU - Law, Matthew
AU - MacHalek, Dorothy
AU - McCaffery, Kirsten
AU - McGrath, Patrick
AU - Mellor, Robert
AU - Norris, Richard
AU - O'Dwyer, Matthew
AU - Pendlebury, Susan
AU - Petoumenos, Kathy
AU - Phillips, Samuel
AU - Poynten, Isobel Mary
AU - Prestage, Garrett
AU - Richards, Adele
AU - Schema, Lance
AU - Seeds, Daniel
AU - Segelov, Eva
AU - Templeton, Dave
AU - Thurloe, Julia
AU - Tong, Winnie
AU - Varma, Rick
AU - SPANC Study Team
PY - 2017
Y1 - 2017
N2 - Anal cytology has been suggested as a screening test for the anal cancer precursor high-grade squamous intraepithelial lesion (HSIL). We aimed to assess the prevalence and predictors of initial unsatisfactory anal cytology tests ('unsats'). The Study of the Prevention of Anal Cancer is a natural history study of anal human papillomavirus (HPV) and precancerous lesions among gay and bisexual men (GBM) of at least 35 years in Sydney, Australia. At each study visit, an anal swab is collected for cytological testing. Unsats are defined as slides with fewer than 2000 nucleated squamous cells and no abnormal cells. Among 617 GBM enrolled, the median age was 49 (range: 35-79) years and 220 (35.7%) were HIV positive. Initial unsats occurred in 61 (9.9%, 95% confidence interval: 7.6-12.5%), and 29 (4.7%, 95% confidence interval: 3.2-6.7%) remained unsatisfactory on repeat cytology. Initial unsats were associated with fewer lifetime anal-receptive partners with a condom (P=0.007); fewer recent anal-receptive sexual partners without a condom (P=0.005); never having had anal chlamydia (P=0.023) or gonorrhea (P=0.003); HIV-negative status (P=0.002); fewer total (P=0.002), low-risk (P=0.005), and high-risk (P=0.015) HPV types detected; lack of anal HPV18 detection (P=0.001); never having anally douched (P<0.001); and douching with soapy water (P=0.009) among those who douched. Unsats were less common among those with histologic HSIL (P=0.008) and nonsignificantly less common among those with fewer anal canal octants affected by HSIL (P=0.080), but were more common among those who felt more nervous (P=0.020) during the examination. Our findings suggest that unsats are more common among GBM with less receptive anal sexual experience. Avoiding douching with soapy water and strategies to aid patient relaxation during sampling may reduce the unsat rate.
AB - Anal cytology has been suggested as a screening test for the anal cancer precursor high-grade squamous intraepithelial lesion (HSIL). We aimed to assess the prevalence and predictors of initial unsatisfactory anal cytology tests ('unsats'). The Study of the Prevention of Anal Cancer is a natural history study of anal human papillomavirus (HPV) and precancerous lesions among gay and bisexual men (GBM) of at least 35 years in Sydney, Australia. At each study visit, an anal swab is collected for cytological testing. Unsats are defined as slides with fewer than 2000 nucleated squamous cells and no abnormal cells. Among 617 GBM enrolled, the median age was 49 (range: 35-79) years and 220 (35.7%) were HIV positive. Initial unsats occurred in 61 (9.9%, 95% confidence interval: 7.6-12.5%), and 29 (4.7%, 95% confidence interval: 3.2-6.7%) remained unsatisfactory on repeat cytology. Initial unsats were associated with fewer lifetime anal-receptive partners with a condom (P=0.007); fewer recent anal-receptive sexual partners without a condom (P=0.005); never having had anal chlamydia (P=0.023) or gonorrhea (P=0.003); HIV-negative status (P=0.002); fewer total (P=0.002), low-risk (P=0.005), and high-risk (P=0.015) HPV types detected; lack of anal HPV18 detection (P=0.001); never having anally douched (P<0.001); and douching with soapy water (P=0.009) among those who douched. Unsats were less common among those with histologic HSIL (P=0.008) and nonsignificantly less common among those with fewer anal canal octants affected by HSIL (P=0.080), but were more common among those who felt more nervous (P=0.020) during the examination. Our findings suggest that unsats are more common among GBM with less receptive anal sexual experience. Avoiding douching with soapy water and strategies to aid patient relaxation during sampling may reduce the unsat rate.
KW - anal canal
KW - anus neoplasms
KW - Australia
KW - cytology
KW - homosexuality
KW - human papillomavirus
KW - male
KW - unsatisfactory
UR - http://www.scopus.com/inward/record.url?scp=85016620053&partnerID=8YFLogxK
U2 - 10.1097/CEJ.0000000000000321
DO - 10.1097/CEJ.0000000000000321
M3 - Article
C2 - 28350724
AN - SCOPUS:85016620053
SN - 0959-8278
VL - 26
SP - 212
EP - 216
JO - European Journal of Cancer Prevention
JF - European Journal of Cancer Prevention
IS - 3
ER -