Application of the Cascade of Care Framework to Guide Evidence-Informed Implementation of Anal Cancer Screening Guidelines.

内容摘要

Most squamous cell carcinomas of the anus, or anal cancers, are attributable to persistent infection with the human papillomavirus (HPV), analogous to cervical cancer. Although rare in the general population, rates of anal cancer are high among people with immune-compromising conditions or a history of HPV-related cancers. Recent evidence demonstrates that treatment of high-grade squamous intraepithelial lesions (HSIL), a precursor of anal cancer, prevents progression to anal cancer. This has motivated the international release of several guideline statements now recommending anal cancer screening. For a new practice of cancer screening to be integrated into routine care for at-risk populations, implementation strategies will need adaptation for local settings. Our aim is to illustrate the potential value of combining the methods of implementation science with the anal screening cascade framework to support evidence-informed adoption of the guidelines across the different clinical services points where patients might undergo anal cancer screening. We point out means by which research activity could be directed, with particular attention to identifying and addressing care gaps to inform the adoption and scale-up of anal cancer screening. These approaches may help to guide local decisions regarding first steps for anal cancer screening implementation, including determining which populations may need enhanced effort, and to identify where more preparation may be needed. It is time to understand how to best implement anal cancer screening. Although rare in the general population, rates of anal cancer are 20 to 100 times higher among people living with HIV, or with solid organ transplants, or among women who have had human papillomavirus-related cancers. Like cervical and colorectal cancer, early detection and treatment can prevent anal cancer. Unlike cervical or colorectal cancer, most jurisdictions do not routinely screen for anal cancer. In 2024, the first international guidelines for anal cancer screening were released. They recommend that clinicians offer screening to people at the highest risk—those who are at greater than 10 times the risk of the general population. In our paper, we describe strategies to evaluate early attempts at anal cancer screening implementation to support efforts to ensure that anal cancer screening becomes part of regular health care for people in whom it is recommended.