58 The Overlooked Malignancy: Anal Cancer in Inflammatory Bowel Disease

Background: Anal cancer incidence is steadily increasing each year, making detection and diagnosis an important aspect of patient care, specifically in patients with inflammatory bowel disease (IBD). Patients with IBD have an increased risk of anal cancer, with other risk factors including human papillomavirus virus (HPV), abnormal cervical pap smears, long standing diagnosis of IBD, anogenital warts, HIV, anal stricture, and perianal Crohn’s disease. Anal cancer symptoms can often be vague and largely go undetected. In these high-risk populations, it is important to screen for anal cancer as part of routine healthcare maintenance for IBD patients. An anal pap smear is the current modality for anal cancer screening followed by a high-resolution anoscopy if positive pap smear results. Methods: This is a retrospective case series analyzing 24 patients with anal pap smears with a diagnosis of IBD and high-risk features such as abnormal pap smears and perianal Crohn’s disease. Anal pap smears were performed prior to endoscopy scheduled procedures and prior to digital rectal examination as per protocol. HPV diagnosis history was also recorded and accounted for each patient if known. Our aim was to screen IBD patients and provide data on the number of positive pap smears and emphasize the importance of early detection and preventative care in increased risk patient populations. Results: Out of the 24 patients, 16 patients had pap smear cytology consistent with atypical squamous cells of undetermined significance (ASCUS). One patient had high grade dysplasia. Five patients were negative. Two had unsatisfactory pap smear cytology results. The patients with ASCUS and high-grade dysplasia were referred to colorectal surgery for high resolution anoscopy. Conclusions: Our study shows the utility and emphasis that should be placed on routine anal cancer screening during colonoscopy in IBD patients with high risk factors for anal cancer. Anal cancer awareness and understanding increased risk factors in IBD patients should not be overlooked as early detection is ideal. While our study assessed the number of positive anal pap smear patients with routine screening, the future direction of the study will include high resolution anoscopy results and percentage of patients positive for anal cancer from routine screening.