The other side of screening: predictors of treatment and follow-up for anal precancers in a large health system.
The other side of screening: predictors of treatment and follow-up for anal precancers in a large health system.
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DOI：
10.1097/qad.0000000000002948
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发表时间：
2021-11-01
期刊：
影响因子：
--
通讯作者：
Sigel K
中科院分区：
文献类型：
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作者：
Silvera R;Martinson T;Gaisa MM;Liu Y;Deshmukh AA;Sigel K
肛门癌对艾滋病毒携带者(PWH)的影响不成比例。高度鳞状上皮内病变(HSIL)是癌的先兆，对其进行治疗可预防肛门癌。关于HSIL治疗和监测依从性的数据有限，但需要确定筛查策略的不足。我们收集了2009年至2019年在一个大型城市肛门癌筛查项目中进行高分辨率肛门镜检查(HRA)的次数和结果的数据。初步诊断为HSIL的患者在HSIL诊断后6个月内复查HSIL电灼消融术，并在HSIL诊断后18个月内随访HRA。我们还在单变量和多变量分析中评估了这些结果的预测因素。1,179名确诊为肛门部单纯疱疹病毒性肠炎的患者被确诊，其中684人(58%)返回进行电灼消融。在接受治疗的患者中，仅有174例(25%)和未经治疗的HSIL患者(495例中的47例)在HSIL诊断后18个月内接受了HRA监测。在多变量分析中，黑人患者和PWH患者在HSIL诊断后6个月内不太可能接受HSIL消融，而商业保险患者更有可能在诊断后6个月内接受治疗。在接受治疗的HSIL患者中，合并病毒血症的PWH患者在HSIL确诊后18个月内进行治疗后监测的可能性较低。即使在大型专门的肛门癌筛查项目中，HSIL治疗和监测的依从性也很低。健康的心理社会和经济决定因素可能会影响护理中的留存。解决患者参与的个人和结构性障碍可能会提高肛门癌筛查的有效性。
Anal cancer disproportionately affects people with HIV (PWH). Highgrade squamous intraepithelial lesions (HSIL) are cancer precursors and treating them might prevent anal cancer. Data on adherence to HSIL treatment and surveillance is limited but needed to identify deficiencies of screening strategies. We collected data on high-resolution anoscopy (HRA) attendance and outcomes from 2009 to 2019 in a large urban anal cancer-screening program. Patients with an initial HSIL diagnosis were followed for return for HSIL electrocautery ablation within 6 months of index HSIL diagnosis, and follow-up HRA within 18 months of index HSIL diagnosis. We also evaluated predictors of these outcomes in univariable and multivariable analyses. One thousand one hundred and seventy-nine unique patients with an anal HSIL diagnosis were identified and 684 (58%) returned for electrocautery ablation. Of those treated, only 174 (25%) and only 9% of untreated HSIL patients (47 of 495) underwent surveillance HRA within 18 months of index HSIL diagnosis. In multivariable analyses, black patients and PWH regardless of virologic control were less likely to undergo HSIL ablation within 6 months of HSIL diagnosis whereas patients with commercial insurance were more likely to be treated within 6 months of diagnosis. Among treated HSIL patients, PWH with viremia had a lower likelihood of engaging in post-treatment surveillance within 18 months of HSIL diagnosis. Even in large specialized anal cancer screening programs adherence to HSIL treatment and surveillance is low. Psychosocial and economic determinants of health may impact retention in care. Addressing both personal and structural barriers to patient engagement may improve the effectiveness of anal cancer screening.