Acknowledgements
ASHM would like to express our sincere appreciation to the following Writing and Committee members for their expertise, commitment, and collaborative efforts in the development of these guidelines. Guideline Committee and Writing Group members: Mary Poynten Andrew Grulich Joe Givan Zoe Sever Richard Hillman Jane Costello Jenny Roberts Mark Bloch Jenny Hoy Jason Ong Richard […]
Appendix
Appendix 1. Details of sampling and reporting Before commencing anal screening, it is advisable to contact your pathologist to obtain advice on appropriate sampling devices and collection media, as samplers and collection fluids are not always interchangeable. It is also important to ascertain whether the laboratory offers NATA-accredited HPV genotyping. At the time of writing, specific Medicare rebates for anal HPV and cytology […]
Useful links & References
Useful Links https://www.svhs.org.au/our-services/list-of-services/hiv-immunology-infectious-disease/dysplasia-and-anal-cancer-services Positive Life NSW International Anal Neoplasia Society Anal Cancer Foundation Summary of Australian recommendations for anal cancer screening in PLHIV Download the Summary here Download Published January 2025 by ASHM. Guidance provided on this resource is based on guidelines and best practices at time of publication References Colon-Lopez V, Shiels M, Machin […]
Anal HSIL treatment
For biopsy-proven HSIL of the anal canal or peri-anus, active treatment has been shown to significantly reduce the incidence of progression to invasive ASCC in PLHIV10. Treatments should aim to eradicate, attenuate, or control disease, while minimising disturbance of normal anorectal function. Indiscriminate wide local excision is therefore no longer recommended, due to the high […]
Management of screening test results
A. Where HRA services are available Abnormal screening results require more detailed investigation, ideally with HRA and biopsy, given that pre-cancerous HSIL lesions are typically asymptomatic and impalpable on DARE. The IANS recommendations for the management of test results modified for “low HRA capacity”, defined as greater than 6 months waiting time for HRA following […]
Key recommendations
Key recommendations of the ASHM Anal Cancer Screening Guidelines Committee In determining specific recommendations for screening to prevent anal squamous cell cancer (ASCC) in PLHIV in Australia, we must acknowledge that the evidence base is limited. However, based on current evidence we recommend: Gay, bisexual and other men who have sex with men (GBM) and […]
Screening Intervals and Cessation
The IANS guidelines acknowledge that there is virtually no evidence available to determine appropriate screening intervals for those who test screen-negative17. The Australian National Cervical Screening Program established in 2017 uses primary HRHPV testing. In non-immunosuppressed individuals, 5-yearly re-screening is recommended in those who screen negative. For PLHIV 3 yearly re-screening is recommended in women […]
Possible anal cancer screening methods
A. High risk HPV (HRHPV) testing For cervical cancer screening, Australia and many other high-income countries have recently changed to a system which uses HPV testing as the primary screening test, because this test has a higher sensitivity than cytology. Compared with cytology testing, anal HRHPV testing has a higher sensitivity (92%) but a lower […]
Methods
Populations to screen Globally, PLHIV experience the highest incidence of ASCC2. Despite the benefits for the health of PLHIV, studies have shown that ART has not led to a reduction in the incidence of anal HSIL or anal cancer among PLHIV4-19. The extraordinarily high incidence of ASCC in PLHIV has become more evident due to […]
Introduction
Anal Cancer Screening Guidelines for PLHIV Last updated: January 2025 Quick access tools Download a pdf version of the guidelines. Guidelines PDF Decision making tool Currently in Australia, referral facilities for diagnostic high resolution anoscopy (HRA) to detect anal high grade squamous intra-epithelial lesions are extremely limited. For at-risk individuals who do not have access […]