Sylvester Science Contributes to Guidelines for Anal Cancer

MIAMI, Fla. (July 23, 2024) – Federal health officials recently released new guidelines for anal cancer screening to protect people with HIV, an achievement made possible by a landmark study conducted at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, and Jackson Memorial Hospital, and other research institutions. 

The U.S. Centers for Disease Control and Prevention guidelines show that it’s better to treat potentially precancerous anal lesions instead of watchful waiting. This could lead to more people getting screened for anal cancer and encourage coverage by insurance companies.

Catching anal cancer before it develops also has the potential to reduce lifelong side effects from cancer treatment (chemotherapy and radiation therapy) and deaths from the disease. Anal cancer kills about 2,190 people annually in the U.S. and claimed the life of actress Farrah Fawcett. 

The guidelines were developed using best-available science, including findings from the ANCHOR study (Anal Cancer/HSIL Outcomes Research), reported in 2022. Treatment reduced the risk of developing anal cancer by about 60% over actively monitoring people over age 35 with HIV. 

“The study had already affected clinical practice and now has been turned into policy,” said Dr. Isabella Rosa-Cunha, the Miller School’s principal investigator for the multi-site study. “This really validates what we have been doing and changes the landscape for anal cancer prevention.”

Dr. Rosa-Cunha is the initiator of the anal cancer prevention program at Sylvester and Jackson Memorial and associate professor at the Miller School. The study, which was led by the University of California, San Francisco, addresses a longstanding question in the field: whether treating anal high-grade squamous intraepithelial lesions (HSIL) or anal pre-cancer lesions prevents anal cancer.

Key provisions in the new guidelines include:

• All adults with HIV should be assessed at least yearly for anal abnormalities like pain and burning and undergo a digital anorectal examination. People under age 35 who are symptomatic or show signs of anal cancer during the examination should undergo standard anoscopy, which involves shining a light through the anus using a small tube. 
• Older people living with HIV should undergo lab-based screening if they are men who have sex with men or transgender women 35 and older; other groups should undergo such screening if they are 45 or older. Lab-based screening includes collection of anorectal specimens as part of an anal “pap smear.”
• For these older groups, people with abnormalities in the lab-based screen or during the anorectal examination should be referred to high-resolution anoscopy (HRA), which uses magnification to assess for abnormal cells.  
• The ANCHOR study findings and other data supported the new guidelines. They were released July 10 by a panel of experts in HIV care, a working group of the NIH Office of AIDS Research Advisory Council, in collaboration with the CDC, the HIV Medicine Association and the Infectious Diseases Society of America.

“I grew up with the field, and to see this happen is really special,” said Dr. Rosa-Cunha, who started the anal cancer prevention program at UM in 2011.

The story about Sylvester’s contributions to the federal guidelines can be found here on the university’s InventUM blog.

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Gary Polakovic

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