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Is There a Proven Link Between Anal Cancer Screening and Reduced Morbidity or Mortality?
- Kenneth A. Katz, MD, MSc, MSCE;
- Christina A. Clarke, PhD, MPH;
- Kyle T. Bernstein, PhD, ScM;
- Mitchell H. Katz, MD; and
- Jeffrey D. Klausner, MD, MPH
- From Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103.
TO THE EDITOR:
We read with interest the study by Chin-Hong and colleagues (1) comparing techniques to detect anal intraepithelial neoplasia (AIN) among men who have sex with men. A more pressing question is whether sufficient evidence of effectiveness, in terms of reducing anal cancer morbidity or mortality, exists to support anal cancer screening. It does not.
No prospective studies, including randomized, controlled trials, have assessed the effectiveness of anal cancer screening (2). Instead, screening proponents have cited indirect evidence, including analogy to cervical cancer screening, to advocate for routine screening among certain populations, such as men who have sex with men (2, 3). As screening proponents rightly note, randomized, controlled trials of Papanicolaou smears for cervical cancer prevention were never conducted; evidence of effectiveness is based on data correlating increased screening and decreased cancer incidence (2).
In San …
