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Targeted anal cancer screening in HIV-infected patients: prevalence of screening indicators

Shalev, Nogaa; Olender, Susan Aa; Chiasson, Mary Annb

doi: 10.1097/QAD.0b013e328336e9a1

aDivision of Infectious Diseases, Columbia University Medical Center, USA

bPublic Health Solutions, New York, New York, USA.

Received 9 December, 2009

Accepted 17 December, 2009

Correspondence to Noga Shalev, MD, Division of Infectious Diseases, Columbia University Medical Center, 622 West 168th Street, Harkness Pavilion 6, New York, NY 10032, USA. Tel: +1 212 305 4707; fax: +1 212 305 7692; e-mail:

We thank Tider et al. [1] for their response to our research letter. The incidence of anal cancer in HIV-infected individuals is far higher than the general population but the utility of screening has not been established [2]. As medical providers to HIV-infected patients, we share the respondents' concerns regarding the excessive morbidity and mortality associated with anal carcinoma. Tider et al. [1] provide a detailed description of anal cancer screening ‘scale up’ in an HIV clinic. However, the authors do not share information about key outcomes, such as the number of patients referred to high-resolution anoscopy, the proportion referred who underwent the procedure, or the correlation between cytological and anoscopic findings. In addition, neither the proportion of patients undergoing treatment, nor treatment response data are presented. These data are essential for guiding clinician practice.

Our concerns about anal cancer screening rest on the fear that screening will result in unnecessary diagnostic work-up and treatment without decreasing morbidity and mortality. As was recently illustrated by the US Preventive Service Task Force's revised recommendations on the use of mammograms [3], the benefit of screening is far more nuanced than our desire to prevent illness.

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1. Tider DS, Rodriguez Caprio G, Gaisa M, Klein RS, Goldstone SE. Successful initiation of an anal cancer screening and treatment program at a New York City HIV clinic. AIDS 2010; 00:000–000.
2. Shalev N, Olender SA, Chiasson MA. Targeted anal cancer screening in HIV-infected patients: prevalence of screening indicators. AIDS 2009; 23:1613–1615.
3. US Preventive Service Task Force. Screening for breast cancer.Ann Intern Med 2009; 151:716–726.
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