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Volume 85 - 2022 - Fasc.4 - Expert Point of View

Diagnosis and screening for anal intraepithelial neoplasia in Belgium: position statement

Anal cancer is an uncommon malignancy, comprising only 2.5% of all gastrointestinal malignancies and similar to cervical cancer, the human papillomavirus (HPV) is responsible for the majority of anal cancers. Over the last decades there has been an up to 3-fold increased incidence seen in specific populations at risk such as persons living with HIV (PLWH), men who have sex with men (MSM), woman diagnosed with HPV-related gynaecological precancerous lesions or cancer, solid organ transplant recipients (SOTR) and patients with autoimmune diseases. Although international practice is evolving increasingly towards active screening for and treatment of anal cancer precursors in at-risk groups, currently no organised screening program is in effect in Belgium. Currently, differerent screening options as well as treatment modalities are available. Before commencing a nationwide organised screening program, essential decisions on screening strategies need to be made, based on both scientific as well as financial and logistical facts. (Acta gastroenterol. belg., 2022, 85, 625-631). Keywords: Anal intraepithelial neoplasia, HPV, anal cancer, screening. Abbreviations: AIN: anal intraepithelial neoplasia; ASCUS: atypical squamous cells of unknown significance; cART: combined antiretroviral therapy; CMV: cytomegalovirus; DARE: digital anorectal examination; ESD: endoscopic submucosal dissection; GBM: gay and bisexual men; HIV: human immunodeficiency virus; HPV: human papilloma virus; HRA: high-resolution anoscopy; HSIL: high grade squamous intraepithelial lesion; IANS: International Anal Neoplasia Society; LSIL: low grade squamous intraepithelial lesion; MSM: men who have sex with men; MSW: men who have sex with women; PAIN: perianal intraepithelial neoplasia; PLWH: persons living with HIV; p16INK4a: cyclin-dependent kinase inhibitor 2A; Rb: retinoblastoma protein; RFA: radiofrequency ablation; SCC: squamous cell carcinoma; SISCCA: superficially invasive squamous cell carcinoma; SOTR: solid organ transplant recipient; URR: upstream regulatory region; VIN: vulval intraepithelial neoplasia; VAIN: vaginal intraepithelial neoplasia