Are Colon and Rectal Surgeons Ready to Screen for Anal Dysplasia? Results of a Survey on Attitudes and Practice

Factor, Stephanie H. MD MPH*; Cooperstein, Amy MPH; Pereira, Guilherme A.; Goldstone, Stephen E. MD§

Sexually Transmitted Diseases: April 2014 - Volume 41 - Issue 4 - p 246–253
doi: 10.1097/OLQ.0000000000000105
Original Study

Background: Colorectal surgeons are ideal referral sources to screen for and treat high-grade anal dysplasia (high-grade squamous intraepithelial lesion [HSIL]) and anal cancer. Anal cytology and high-resolution anoscopy (HRA) using acetic acid and magnification are optimal methods for screening. We endeavored to determine US colorectal surgeons’ attitudes and practices regarding HSIL screening.

Methods: An Internet-based survey with questions related to clinician demographics and attitudes and practices regarding anal dysplasia was sent to US members of the American Society of Colon and Rectal Surgeons.

Results: Of 1655 requests, 290 (18%) eligible participants responded. Most were white (83%), male (76%), board-certified colorectal surgeons (89%), and graduating medical school after 1990 (54%), almost all treated patients at risk for anal cancer and had read research on HSIL. Approximately one-third of respondents had performed anal cytology, and one-third had performed HRA. When evaluating patients for HSIL in surgery, only 31% use acetic acid with magnification. Of 99 participants who perform HRA, 46% were formally trained, 83% primarily do HRA primarily in the operating room, and 82% use acetic acid with magnification. Knowledge of HSIL risk factors was not associated with screening. Women, more recent graduates, and surgeons with higher percentages of HIV-infected patients were more likely to screen. Screening barriers included no training (52%), not a priority (23%), lack of evidence (21%), and cost (8%).

Conclusions: American Society of Colon and Rectal Surgeons members responding to the survey by and large do not screen for anal dysplasia. Those that do are often not formally trained and use inadequate technique.

Colon and rectal surgeons responding to the survey by and large do not screen for anal dysplasia. Those that do are often not formally trained and use inadequate technique.

From the *Departments of Medicine and †Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY; ‡Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil; and §Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Funding: Dr. Goldstone paid for the cost of submitting the survey charged by the American Society of Colon and Rectal Surgeons from his personal funds.

Guilherme A. Pereira received a scholarship from Brazil Scientific Mobility Program, organized by Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil.

Podium Presentation S53 at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting Phoenix, AZ; April 27–May 1, 2013.

Author contribution: Amy Cooperstein: study design, implementation, data analysis, writing of draft, and approval of the final manuscript; Guilherme A. Pereira: data analysis, statistical analysis, writing of draft, and approval of the final manuscript; Stephanie H. Factor: data analysis, statistical analysis, writing of draft, and approval of the final manuscript. Stephen E. Goldstone: study design and implementation, data analysis, writing of the manuscript draft, and approval of the final manuscript.

Financial conflicts of interest: None of the authors have any conflicts of interest related to this manuscript to report.

Disclaimers: None.

Correspondence: Stephen E. Goldstone, MD, Department of Medicine, Icahn School of Medicine at Mount Sinai, 420 West 23rd St, New York, NY 10011. E-mail: goldstone.stephen@gmail.com.

Received for publication September 11, 2013, and accepted January 2, 2014.

© Copyright 2014 American Sexually Transmitted Diseases Association