(P163) A Retrospective Chart Review of Anal Dysplasia Screening Practices among High-Risk Populations in an Academic Medical System

Background: Anal squamous cell cancer disproportionally affects certain populations, including individuals with a history of HIV, condyloma acuminata, gynecologic cancers, and solid organ transplantation. While some experts recommend anal cancer screening for persons living with HIV (PWH), historical screening practices are understudied, and there is no consensus on screening for other higher-risk groups. Our objective was to characterize anal cancer screening practices among PWH and other higher-risk populations in an academic medical system.

Methods: We extracted outpatient clinical data for patients with a history of HIV, condyloma acuminata, cervical, vulvar, or vaginal (i.e. gynecological) cancer, or solid organ transplantation with at least two clinical visits during 01/01/2015 - 08/01/2022 at three affiliated sites of a Massachusetts-based academic medical center (Beth-Israel-Lahey). Data included patients’ demographics, medical diagnoses, and anal cytology or human papillomavirus (HPV) testing dates. We used chi-squared tests to assess for associations between race and anal cancer screening within priority populations.

Results: Of 7616 patients, 4.8% received anal cytology testing during the seven-year study period, with 1.7% of patients receiving HPV co-testing. Among those screened, 61.1% were non-Hispanic White, 19.9% were non-Hispanic Black; 57.3% had Medicare or Medicaid and 40.2% had private insurance. Most of those screened had HIV (80.1%), while other diagnoses included condyloma acuminata (44.2%), gynecologic malignancy (7.5%), or solid organ transplantation (3.9%); many patients had more than one of these diagnoses. In the overall cohort, screening levels were highest for PWH (18.3%) and lower for those with histories of condyloma acuminata (11.2%), gynecologic cancers (1.2%), or solid organ transplantation (0.4%). Non-Hispanic White patients were more likely than non-Hispanic Black patients to be screened for anal cancer among PWH (p< .00001) and among those with gynecologic cancers (p=.002), but not among those with condyloma acuminata or solid organ transplantation.

Conclusion: The majority of PWH in an academic medical system did not receive anal cancer screening during a seven-year period, and racial inequities existed in rates of screening; minimal screening was performed in other higher-risk populations. Studies are needed to evaluate barriers to effective and equitable anal cancer screening among priority populations.