ArticleThe open AIDS journal2007
Early impact and performance characteristics of an established anal dysplasia screening program: program evaluation considerations.
Article in The open AIDS journal, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta-analysis of cytology, HPV testing, and other biomarkers.Cancer cytopathology · 2018Pooled it
- Pooled it
- Natural history of anal dysplasia in an HIV-infected clinical care cohort: estimates using multi-state Markov modeling.PloS one · 2014Trial
- Clinical Predictors and Outcomes of Invasive Anal Cancer for People With HIV in an Inception Cohort.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Automated analysis of scattering-based light sheet microscopy images of anal squamous intraepithelial lesions.Biomedical optics express · 2024Article
- Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection.Microorganisms · 2022Review
- Feasibility and safety study of a high resolution wide field-of-view scanning endoscope for circumferential intraluminal intestinal imaging.Scientific reports · 2021Article
- High-resolution anoscopy in HIV-infected men: Assessment of the learning curve and factors that improve the performance.Papillomavirus research (Amsterdam, Netherlands) · 2019Article
- History of High-Resolution Anoscopy.Clinics in colon and rectal surgery · 2018Review
- Estimating the accuracy of anal cytology in the presence of an imperfect reference standard.PloS one · 2010Article
- Screening HIV-infected patients for non-AIDS-defining malignancies.Current HIV/AIDS reports · 2009Review
- Anal squamous cell carcinoma in the HIV-positive patient.Clinics in colon and rectal surgery · 2009Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundScreening for invasive anal cancer and its precursors is being increasingly advocated as a response to increasing incidence among HIV-infected persons. We implemented a comprehensive screening program in 2001 and report our early experience to inform monitoring and evaluation of such programs. Our research aims were: (1) to estimate incidence of and mortality from invasive anal cancer (IAC) before (1995-2000) and after (2001-2005) screening program implementation and (2) to examine potential screening program quality indicators.
methodsThe study cohort included all patients under care for HIV infection at UCSD Owen Clinic between 1995-2005. Person-time incidence rates (IR) and case survival of IAC were estimated for the pre-screening (1995-2000) and post-screening (2001-2005) periods. High resolution anoscopy (HRA) operator accuracy was estimated by kappa agreement between cyto-histologic comparisons. Program quality indicators included: (1) screening coverage; (2) percent technically unsatisfactory cytology smears; (3) time between 1st abnormal cytology and 1st HRA; and (4) time between last clinic visit and last cytology.
results28 cases of IAC and 13,411 person-years were observed between 1995-2005. IRs (95% CI) pre-screening and post-screening were 199 and 216 per 100,000 person-years, respectively. There was no routine treatment of high grade squamous intraepithelial lesions (HSIL) during the study period. The percent of patients with IAC requiring chemoradiation decreased from 90.9% to 70.6% (p=0.36). There was a significant improvement in cyto-histologic agreement at HRA with increasing operator experience (r=0.92, p=0.025). Screening coverage was 73% of the target population. Among 14 providers, the percent unsatisfactory cytology smears averaged 27% but varied from 0 - 62%. The median time from 1st abnormal cytology to 1st HRA was 258 days. The median interval between the last cytology and the last clinic visit was 207 days.
conclusion(1) The overall IR of IAC did not decline in the screening era and was higher than previous estimates for HIV cohorts; (2) stage shift to IAC of more favorable prognosis is a reasonable screening goal; (3) HRA accuracy varied by provider experience; (4) because of delay in access to HRA, digital rectal exam should be combined with cytology screening to detect palpable disease.
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Registered trials
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