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IMPROVING HPV-RELATED ANAL CANCER SCREENING: UNDERSTANDING PHYSICIAN BARRIERS
Dharma Ayer
*, Mona Ardeshna, Shreya Patel, Julia Liporace Hall, Sandra Dibrito
Albany Medical College, Albany, NY
Introduction:
Human papillomavirus (HPV) infection is the most important risk factor for anal cancer. Though anal pap smears are an effective initial screening tool, many clinicians underestimate the patients at risk and face barriers preventing appropriate screening. The objective of this study was to assess physician practices and perceived barriers to HPV-related anal cancer screening to identify areas for improving screening rates and patient care.
Methods:
Physicians were queried using a brief 7-question survey developed to assess their practices and perceived barriers regarding HPV-related anal cancer screening. The survey included questions about demographics (e.g., specialty, years in practice, practice setting), patient screening factors (e.g., MSM, HIV-positive, immunocompromised), and barriers to screening (e.g., lack of training, time constraints, stigma). It also captured the standard practices for anal Pap smears when a patient has a positive cervical Pap result. Surveys were distributed via an anonymous link to providers within the region in different practice settings. The data were then analyzed to assess whether providers perform anal Pap smears, which patient indications prompt screening, and the barriers they encounter.
Results:
Of the 100 surveys distributed, 42 were returned. Most physician respondents were gynecologists (55%), with others including internists (19%), family medicine providers (19%), and other (7%). Most respondents had over 4 years of experience in practice (95%), with 52% having over 15 years of experience. Out of all respondents, only 5% said they order and perform anal Pap smears when a patient has a positive cervical Pap result. Additionally, 67% reported they believe there are barriers that exist in screening for anal cancer within their practice, with the most common being a lack of training (40%) and not knowing the indications (36%). Furthermore, many physicians expressed unfamiliarity with the guidelines and referral process in cases where a patient receives a positive anal Pap smear result.
Conclusion:
There is a clear clinical gap in anal cancer screening with many providers underutilizing anal pap smears, even for high-risk patients like those with positive cervical pap results. The main barriers include a lack of training and unfamiliarity with screening indications. Given the practical opportunity to screen for anal cancer during cervical pap exams, providing physicians with better education on screening guidelines and integrating reminders into electronic medical record systems could improve screening rates and ensure appropriate referrals for specialized care.
Figure 1: Barriers to HPV-related anal cancer screening reported by surveyed physicians (n = 42). The most frequently cited barriers included a lack of training to perform the test (n = 17, 40%) and unfamiliarity with the screening indications (n = 15, 36%). Other barriers include patient reluctance, lack of knowledge on interpreting results, time constraints, and stigma. Few respondents (n = 6, 14%) reported no barriers to screening.
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