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Low Adherence to Treatment and
Follow-up of Anal Cancer Precursor
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CROI 2020, March 8-11, 2020, Boston
Mark Mascolini
Only half of people with an anal cancer precursor adhered to treatment in a large US academic center, and only half adhered to surveillance recommendations [1]. The findings are particularly relevant for people with HIV, who run a high risk of anal cancer, although HIV status did not predict surveillance rates in this study group.
People with HIV run nearly a 20 times higher risk of anal cancer than people in the general population, noted researchers from the Icahn School of Medicine at Mount Sinai, who conducted this study. Several professional groups, including the HIV Medicine Association (HIVMA) and the British HIV Association (BHIVA), recommend that people with HIV have anal cancer screening starting with anal cytology or high-resolution anoscopy (HRA)-guided biopsy and treatment of high-grade intraepithelial lesions (HSIL). Untreated HSIL, the Mount Sinai team warned, can progress to invasive anal cancer. HSIL recurrence after treatment in more than 50% of cases makes ongoing surveillance necessary.
This analysis involved 3646 people with at least one HRA in the Mount Sinai system in 2009-2019. More than 10% of this group, 387 people, had biopsy-proven HSIL. The investigators set out to assess adherence to any HRA surveillance, surveillance within 18 months of initial HSIL diagnosis, lesion ablation within 6 months of HSIL diagnosis, and surveillance after ablation.
Among 3646 people who had anal cancer anoscopy, 387 (11%) got diagnosed with HSIL. Among people with HSIL and gender status recorded for this study, 346 were male and 40 female. Of the 387 people with HSIL, only 202 underwent ablation within 6 months to yield a treatment adherence rate of 52%.
Among the 387 people with HSIL, 193 (50%) had any follow-up surveillance and only 67 (17%) had surveillance within 18 months. Among the 202 people who underwent ablation, 193 (95%) had any surveillance and 62 (31%) had surveillance within 18 months.
In the 387-person HSIL group, only one variable assessed--Hispanic ethnicity--predicted any follow-up surveillance (59% among Hispanics, 49% among whites, and 43% among blacks, P = 0.02). Variables that did not predict any surveillance were sex, age, heterosexual versus same-sex status, HIV status, or time to follow-up (median 31.7 months). No variable predicted surveillance within 18 months.
The low rates of adherence to treatment and surveillance at a New York medical center known for its work in anal cancer led the investigators to call for research into adherence barriers and facilitators.
Reference
1. Silvera R, Gaisa M, Liu Y, et al. Low adherence to treatment and surveillance of HPV-related anal cancer. Conference on Retroviruses and Opportunistic Infections (CROI). March 8-11, 2020. Boston. Abstract 621.
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