S643 Current Recommendations for Screening Guidelines in the Management of Anal Cancer for High-Risk Populations: A Review

Introduction: Anal cancer in the general population is rare. However, the incidence has increased the last several decades in high-risk populations including people with human immunodeficiency virus (HIV), people who are immunocompromised, human papillomavirus (HPV) positive infection, high risk sex behaviors, men who have sex with men (MSM), and/or engaging in unprotected anal sex. Since anal cancer continues to rise in certain populations, it is imperative to investigate if screening tools should be implemented to prevent and better treat anal cancer if detected early. As it stands currently, there are no screening guidelines for anal cancer in high-risk groups. Methods: Rayyan website use to stratify articles based on abstract and title with inclusion criteria of anal cancer. Inclusion criteria included: anal cancer and screening guidelines or diagnostic High-risk populations also included HIV, HPV, MSM populations according to existing guidelines. While HPV is related to both anal and cervical cancer, if the article just talked about cervical cancer, then it was excluded. Exclusion criteria included: if the paper was not written in English without translation provided, if the paper was published before 2000, if other cancers were mentioned, or if other clinical outcomes were reported not in the scope of this systematic review. Fifty-two articles were included. Results: Multiple studies reported evidence of potential biases and disparities when discussing anal cancer screening. Compared with White men, Asian men were less likely to have discussed screening with a healthcare provider or to have been screened by digital anal rectal examination or anal cytology/anoscopy. Men who identified as African, Caribbean, or Black were less likely to have had digital anal rectal examination. These results remained consistent when restricting the analyses to gay, bisexual, and men who have sex with men. It is imperative to be conscious of implicit biases, so it does not affect the care patients receive and deserve. Conclusion: With the increasing incidence of anal cancer in high-risk populations, this systematic review sought to review current literature to determine the potential role of standardized screening guidelines for anal cancer for prevention and early detection. Without universal and standardized guidelines, as it stands currently, there is likelihood of bias and inconsistency when determining who to screen.