As with cervical, vaginal, and vulvar cancer, anal cancer is largely caused by prior infection with high-risk human papilloma virus (HPV). Although the groups at highest risk are people living with HIV (PLHIV) and men who have sex with men (MSM), the majority of cases worldwide is in women. Like other HPV-mediate cancers, there are high-grade precursor lesions that can be detected with acetic acid staining in a procedure known as High Resolution Anoscopy (HRA).
Intuitively, HRA-guided treatment of high-grade lesions will lead to a reduction in the incidence of invasive anal cancer; however, it was not until the publication of the multicentre US ANCHOR study that this could be considered standard of care. A number of ablative treatments are available for anal pre-cancer, such as laser and electrocautery. The International Anal Neoplasia Society (IANS) has also developed evidence-based screening guidelines for at-risk groups, which include women living with HIV and those with a history of other HPV-related neoplasia.
Given the mandate to screen and treat, considerable capacity building is required in Australia, where HRA services are offered in only three states. IANS is the peak body for HRA training and certification, which is potentially available for health professionals from all disciplines.