ASHM, January 2025
Summary of Australian recommendations for anal cancer screening in PLHIV
While uncommon in the general population, the incidence of anal squamous cell carcinoma (ASCC) is increasing, and certain groups, including people living with HIV (PLHIV) are disproportionately affected.
While anal cancer can affect people of all ages, unlike cervical cancer, rates do not start rising until 35 years or older and continue to rise with increasing age.
In 2023, ASHM committed to providing recommendations and standards of care for the prevention and early detection of anal cancer in PLHIV.
The four priority areas for guidelines development in Australia were:
(1) establish the ASCC incidence in PLHIV to substantiate the benefits of screening in this population,
(2) ASCC screening tools and testing algorithms,
(3) management of screening results and
(4) treatment of anal HSIL.
The recently published IANS consensus guidelines for ASCC screening and US DHHS recommendations form the basis of Australia-specific recommendations.
The recommendations in these guidelines are designed to:
1. Improve awareness among clinicians involved in the care of PLHIV, and among PLHIV, of ASCC as one of the most common cancers in this population
2. Improve awareness and availability of screening for anal precancers by building on existing international guidelines and the evidence-base for ASCC screening
3. Assist clinicians to identify and screen PLHIV at higher risk of ASCC
4. Assist in triaging to prioritise screening and referral of PLHIV at highest risk while screening and treatment services capacity is expanded in Australia