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

Sep 22, 2026

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Most anal squamous cell carcinomas are driven by persistent human papillomavirus (HPV) infection, and recent evidence shows that treating high-grade squamous intraepithelial lesions (HSIL) can prevent progression to anal cancer. International guideline statements now recommend anal cancer screening, but implementation into routine care for at-risk populations requires adaptation to local contexts. The work illustrates how combining implementation science with the anal screening cascade can support evidence-informed adoption, identify care gaps, and guide initial scale-up steps.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Rationale for anal cancer screening

Implementation approach using the Cascade of Care framework

Integrating evidence-informed adoption across clinical services

Application of the Cascade of Care Framework to Guide Evidence-Informed Implementation of Anal Cancer Screening Guidelines Cancer Control Volume 33: 1–8 © The Author(s) 2026 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions) [DOI: 10.1177/10732748261466365](DOI: 10.1177/10732748261466365) [journals.sagepub.com/home/ccx](journals.sagepub.com/home/ccx) Ann N. Burchell, PhD1,2,3, Troy Grennan, MD4,5, Christine Fahim, PhD3,6, Dina Gaid, PhD2, Apondi J. Odhiambo, PhD2,3, and Shuk On Annie Leung, MD7 Abstract 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-gradesquamous 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. Plain Language Summary 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 screeningto people atthe 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. 1Department of Family and Community Medicine, Temerty Faculty of Medicine, University of TorontoToronto, Ontario, Canada 2MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 4Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada 5Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 6Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada 7Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada Corresponding author: Ann N. Burchell, PhD, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria

FAQs

What evidence supports the prevention of anal cancer discussed in the paper?

The paper notes that treating high-grade squamous intraepithelial lesions (HSIL), a precursor to anal cancer, can prevent progression to anal cancer.

Why does the paper focus on implementation strategies for anal cancer screening guidelines?

Because integrating new screening into routine care for at-risk populations requires adapting implementation strategies to local healthcare settings.

How does the paper propose to use the Cascade of Care framework in practice?

It illustrates combining implementation science methods with the anal screening cascade to support evidence-informed guideline adoption and scale-up across different clinical service points.

Sep 22, 2026

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