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International Anal Neoplasia Society guidelines recommend digital anal rectal examination (DARE) and anal swab-based screening of high-risk individuals using high-risk HPV testing or cytology. Using a biobank of over 600 high-resolution anoscopy screened participants (94% men with HIV), projected outcomes were compared across single-test, co-testing, and two-step algorithms requiring one or two positive results for HRA referral. The lowest missed HSIL rate occurred with hrHPV testing alone or combined with cytology. Screening strategies rely on close monitoring to adapt programs.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/swab-based-anal-cancer-screening-in-men-living-with-hiv-projected-outcomes-for-different-screening-algorithms/374821/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/swab-based-anal-cancer-screening-in-men-living-with-hiv-projected-outcomes-for-different-screening-algorithms/374821.png","ImageObject",300,407,{"name":92,"@type":93},"Kurz","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the purpose of anal cancer screening in this study?","Question",{"text":113,"@type":114},"To compare screening algorithms aimed at preventing anal cancer by detecting and enabling treatment of HSIL precursor lesions.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which screening strategy missed the fewest HSIL lesions in the projections?",{"text":118,"@type":114},"High-risk HPV (hrHPV) testing, either alone (14.2%) or combined with cytology using specified thresholds, showed the lowest missed HSIL percentages.",{"name":120,"@type":111,"acceptedAnswer":121},"How were participants referred for high-resolution anoscopy (HRA) in different algorithms?",{"text":122,"@type":114},"Algorithms used single-test, co-testing, or two-step testing and varied the number of positive tests required for HRA referral, producing different referral rates.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},374821,1790471138,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},2336478945635,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","DOI: 10.1002/ijc.70046  \nRES EARCH A RTICLE  \nCa ncer Epidemiology  \nSwab-based anal cancer screening in men living with HIV: Projected outcomes for different screening algorithms  \nKirsten Rozemeijer 1,2  | Fernando Dias Gonçalves Lima 1,2,3,4  | Esther J. Kuyvenhoven 3,4 | Henry J. C. de Vries 3,5,6,7 |  \nRenske D. M. Steenbergen 1,2  | Jan M. Prins 4 | Matthijs L. Siegenbeek van Heukelom 3  \n1Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands  \n2Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands 3Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands  \n4Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands  \n5Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands 6Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands 7Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands  \nCorrespondence  \nMatthijs L. Siegenbeek van Heukelom, Department of Dermatology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. [Email:](Email: m.l.vanheukelom@amsterdamumc.nl)[ m.l.vanheukelom@amsterdamumc.nl](Email: m.l.vanheukelom@amsterdamumc.nl)  \nAbstract  \nScreening for and treatment of anal cancer precursor lesions, high-grade squamousintraepithelial lesions (HSIL), can prevent anal cancer. Recent guidelines set by the International Anal Neoplasia Society recommend digital anal rectal examination (DARE) and anal swab-based screening of high-risk individuals by means of high-risk (hr)HPV testing or cytology. We used our biobank containing data of more than 600 high-resolution anoscopy (HRA) screened participants (94% men with HIV) to compare the possible screening algorithms. We selected the 298 screening participants in whom anal swabs were successfully tested for hrHPV and cytology, parallel to HRA screening (DARE followed by complete visual inspection by HRA) . We compared outcomes of several strategies (single-test, co-testing, two-step testing) with one or two positive tests required for HRA referral, resulting in 20 possible screening algorithms. We also assessed the sensitivity of DARE to detect anal cancer. We found that the percentage of missed HSIL was lowest with hrHPV testing, either alone (14.2%) or combined with cytology (≥ASCUS threshold: 4.4%; HSIL threshold: 8.8%) (co-testing or two-step testing, with ≥1 positive test required for HRA referral) . Using these screening algorithms, 61.0 %, 79.0 %, and 63.7% of the participants were referred for HRA. While in some scenarios a small percentage of cancers was missed, all were detected by DARE. Whatever strategy is chosen, screening outcomes will have to be monitored closely to evaluate the program and make adaptations when necessary.  \nKEYWOR DS  \nanal cancer, cancer screening, cytology, human papillomavirus viruses, test taking strategies  \nAbbreviations: AIN, anal intraepithelial neoplasia; ASCUS, atypical squamous cells of undetermined significance; DARE, digital anal rectal examination; FFPE, formalin-fixed and paraffinembedded; HPV, human papillomavirus; HRA, high-resolution anoscopy; hrHPV, high-risk human papillomavirus; HSIL, high-grade squamous intraepithelial lesion; IANS, International Anal Neoplasia Society; LAST, Lower Anogenital Squamous Terminology; LSIL, low-grade squamous intraepithelial lesion; MSMLWH, men who have sex with men living with HIV; PLWH, people living with HIV; TWLWH, transgender women living with HIV.  \nJan M. Prins and Matthijs L. Siegenbeek van Heukelom shared last authors and contributed equally to this study.  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2025 T","cbCaig1D4ArWE79h","https://ap.wps.com/l/cbCaig1D4ArWE79h","pdf",769093,"English","# Abstract\n# Introduction\n## Background and rationale for anal cancer screening\n## Screening tests and implementation considerations","[{\"question\":\"What is the purpose of anal cancer screening in this study?\",\"answer\":\"To compare screening algorithms aimed at preventing anal cancer by detecting and enabling treatment of HSIL precursor lesions.\"},{\"question\":\"Which screening strategy missed the fewest HSIL lesions in the projections?\",\"answer\":\"High-risk HPV (hrHPV) testing, either alone (14.2%) or combined with cytology using specified thresholds, showed the lowest missed HSIL percentages.\"},{\"question\":\"How were participants referred for high-resolution anoscopy (HRA) in different algorithms?\",\"answer\":\"Algorithms used single-test, co-testing, or two-step testing and varied the number of positive tests required for HRA referral, producing different referral rates.\"}]","Swab-based anal cancer screening in men living with HIV - Projected outcomes for different screening algorithms | PDF",1790202495,25]