The article by Raptis and colleagues provides an excellent overview on the current state of the diagnostic evaluation and therapy of anal carcinoma (1). We wish to comment on three particular aspects in the article.
Similar to cervical cancer, anal cancer is potentially preventable by means of screening examinations. The authors mention that so far, no internationally accepted guidelines have been issued on the screening of high risk groups. Although that is correct, a German-Austrian guideline has existed since 2013, which was published by the Association of the Scientific Medical Societies in Germany (AWMF), on the prevention, diagnostic evaluation, and therapy of anal dysplasias and carcinomas in HIV-infected individuals (2). This guideline recommends, in addition to clinical inspection of the anogenital region and digital rectal examination, anal cytology testing and, in case of a pathological findings or in patients at particularly high risk, they additionally recommend high-resolution anoscopy with biopsy, in analogy to colposcopy.
The authors mention that so far, no recommendations exist with regard to vaccination against anal cancers. A large controlled study showed the efficacy of the prophylactic quadrivalent HIV vaccine in preventing anal dysplasias in men who have sex with men (MSM). For this reason, as well as for the purpose of preventing genital warts, vaccinating MSM is explicitly recommended in the United Kingdom, since MSM do not benefit from the herd immunity conferred by vaccinating girls (3).
The authors say that according to US and European guidelines, primarily surgical treatment is indicated only in well differentiated cancers of the anal margin in stage T1. A recently published study showed, however, that T1 cancers localized in the anal canal can also be treated curatively by using excision and a safety resection margin <5 mm (4). It was thus possible to avoid radiotherapy, as is otherwise recommended in early invasive cancers of the anal canal.
Footnotes
Conflict of interest statement
Prof Kreuter has received lecture honoraria for lectures and consultancy fees (advisory board) from MSD Sanofi Pasteur. Dr Esser has participated as a local investigator in Germany in the “Human Papillomavirus Quadrivalent Vaccine Study” of Merck and MSD Sanofi Pasteur. Prof Wieland has received lecture honoraria from ViiV Healthcare, Becton Dickinson, and A&O Labor Delitzsch.
References
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