Anal HPV, Dysplasia Associated With Cervical HPV

Norra MacReady

July 09, 2014

Women with high-grade cervical dysplasia associated with human papillomavirus (HPV) infection also are likely to have abnormal anal cytology and high-risk anal HPV, the authors of a new study report.

The findings add to a growing body of evidence suggesting "that in addition to being at higher risk of developing cervical cancer, women with high-grade cervical dysplasia may have an elevated risk of anal cancer," lead author Jacqueline Lammé, MD, from the Department of Obstetrics Gynecology, Naval Medical Center, San Diego, California, and colleagues write in an article published in the August issue of Obstetrics & Gynecology.

The presence of high-grade squamous intraepithelial lesions is a known risk factor for cervical cancer, the authors write. It is hypothesized that these lesions may also be a precursor to anal cancer. However, "[f]ew studies have addressed the role of screening for the important high-risk group comprised of women with high-risk cervical abnormalities without a history of HIV," and the US Preventive Services Task Force does not currently endorse any screening guidelines for precancerous anal lesions. However, recent evidence suggests there might be a link among cervical cancer, anal cancer, and high-risk HPV. The authors conducted a descriptive, prospective cohort study to examine the correlation between cervical dysplasia and anal HPV. A secondary aim of the study was to examine the relationship between the severity of cervical dysplasia and the presence of anal dysplasia and anal HPV.

The participants were women referred to the dysplasia clinic at the Naval Medical Center San Diego for evaluation of abnormal cervical Papanicolaou test (Pap test) results. Patients were eligible if the Pap test showed atypical squamous cells of undetermined significance with HPV (ASC-US/HPV+) and atypical squamous cells (cannot rule out high-grade dysplasia [ASC-H], low-grade squamous intraepithelial lesions [LSIL], or high-grade squamous intraepithelial lesions [HSIL]). Patients in the 3 latter groups were tested for HPV at the time of colposcopy. The researchers excluded women if they were younger than 21 years, were pregnant, were HIV-positive, had atypical glandular cells, or had undergone total hysterectomy.

All patients underwent routine colposcopy with endocervical curettage and cervical biopsies. Those in the ASC-H, LSIL, and HSIL groups were also tested for cervical and anal HPV. Patients with positive anal cytology were referred to the Department of Colorectal Surgery for follow-up care.

All of the 196 women initially enrolled in the study underwent anal Pap tests, but the samples were insufficient in 26 of them. Of the 170 women for whom results were available, 85 (50%) were 21 to 25 years of age, 37 (21.8%) were 26 to 30 years of age, 30 (17.6%) were aged 31 to 40 years, 6 (3.5%) were 41 to 50 years of age, and 12 (7.1%) were more than 50 years of age.

Anal cytology was normal in 140 patients (82.4%). ASC-US was seen in 20 (11.8%) patients, and 10 (5.9%) had LSIL. None of the patients had ASC-H or HSIL. The overall incidence of high-risk anal HPV was 32.5%, and the overall prevalence of concurrent abnormal anal cytology was 17.6%. On standard logistic regression analysis, the odds ratio (OR) of anal HPV in a woman with cervical HPV was 3.6 (95% confidence interval [CI], 1.19 - 10.77; P < .024). For a woman with anal HPV, the OR for anal dysplasia was 6.5 (95% CI, 2.74 - 15.60; P < .001). The study was not powered to analyze the relationship between cervical and anal dysplasia.

The main drawback of the study was its relatively small sample size. However, "it was unique in looking at a population specifically at risk given their known cervical abnormalities," the authors write. "At this time, the natural progression of anal dysplasia in relation to the onset of cervical dysplasia is yet unknown. As our patients are followed over time, this relationship may become clearer." Long-term follow-up will be essential, as a decade or more may elapse before anal cancer develops in women with HPV-related gynecologic cancers.

This research was supported by Admiral’s Research Grant. The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2014;124:242-248.

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