“Do I Need an Anal Pap?”: Partnering in Preventive Care: A Shared Decision-Making Approach to Anal Pap Testing in IBD

Lay Summary Patients with inflammatory bowel disease, particularly those with Crohn’s disease and perianal disease, are at increased risk for human papillomavirus–associated anal intraepithelial neoplasia and squamous cell carcinoma. We review the epidemiologic and pathophysiologic mechanisms underlying this risk, outline the test characteristics and clinical utility of anal cytology and high-resolution anoscopy, and summarize current screening recommendations from U.S. and international guidelines. We discuss the role of shared decision making and a risk-based framework to help guide personalized anal Pap test screening based on individual patient clinical profiles.