Question

Recently had anal pap smear. They found whole list of high risk types (almost all. Thay also noted abnormal cells. my score was 9.7 which they said was high. I am having an autologous stem cell transplant for HIV related Plasmablastic Non-Hodgkins. I have been in first CR for 6 months. I had anal warts (suspected). They were frozen and have not returned. They want to do a anal scope to see if I have a squamous lesion inside. I have no syptoms, normal bowel movements no pain. I do not want the colonoscopy as I avoid all invasive procedures. Please advise if this is overkill and if I have a good argument to refuse. I know there is much controversy as to whether high risk hpv even causes anal cancer.Do I have an argument against the procedure

Answer

It would be prudent for you to consider anoscopy with planned ablation of intra-anal dysplasia (if identified). This would be analogous to a female having colposcopy for management of an abnormal cervical PAP smear. A complete colonoscopy may not be necessary unless you are over 50 years old or have a family history of colon cancer. I don't think that there is controversy about the linkage of high-risk HPV to anal cancer but rather the controversy is whether screening and early pre-emptive treatment can prevent anal cancer from developing. It makes intuitive sense that this strategy would work, but to my knowledge there are no controlled trials that prove this approach is effective.