Missed opportunities for anal cancer (AC) screening in women living with HIV: results from a survey across the European region

Objective The incidence of anal cancer (AC) is higher in women with HIV than in women without HIV due to immunosuppression and persistence of human papilloma virus (HPV). Since 2024, the International Anal Neoplasia Society’s and European AIDS Clinical Society (EACS) guidelines recommend annual AC screening of cisgender women (CW) of ≥45 years old, transgender women (TW) of ≥35 years old and women with previous vulvar high-grade squamous intraepithelial lesion (HSIL)/cancer regardless of age. This study describes current clinical practices and protocols for AC screening in women with HIV within healthcare settings across WHO European Region (WER). Methods Between November 2024 and January 2025, an anonymous online survey on AC screening and prevention in persons with HIV was disseminated among healthcare workers in the WER via the EACS website, social networks and e-mails. Results Among the 240 participants, 28.1% declared following national AC screening guidelines. Of those, 43.3%, 20.9% and 19.4% stated that CW, TW and women with previous vulvar HSIL/cancer, respectively, were not included in AC screening guidelines. Of those who answered the question, 37.7% respondents routinely asked CW about AC symptoms; 12.5% and 25.0% of respondents performed digital anal rectal examination annually in cis and trans gender women, respectively. Anal cytology was not routinely available in 23.2% and HPV genotyping in 20.8% of clinical settings. High-resolution anoscopy was not accessible for 37.2% of respondents and was more available in Western (68.2%) than in Central/Eastern Europe (44.6%). 26.4% of respondents did not routinely suggest HPV vaccination to adult CW. Main barriers to AC screening among women were lack of resources (47.9%), integrated resources (47.5%) and guidelines (46.6%). Conclusion Women with HIV are often omitted in national guidelines and practices for AC screening in Europe. Screening methods are often not accessible. More education of healthcare workers is needed about benefits of AC screening and HPV vaccination for women with HIV.