The accuracy of anal self- and companion exams among sexual minority men and transgender women : a prospective analysis
© 2024 The Author(s)..
Background: Squamous cell carcinoma of the anus (SCCA) annual incidence among sexual minority men with and without HIV is 85/100,000 and 19/100,000 persons, respectively, which is significantly higher than the overall incidence (2/100,000). Incidence may also be higher in transgender women. Since SCCA tumours average ≥30 mm at diagnosis, we assessed the accuracy of individuals to self-detect smaller anal abnormalities.
Methods: Using convenience sampling, the study enrolled sexual minority men and transgender women, aged 25-81 years, in Chicago, Illinois and Houston, Texas, USA, during 2020-2022. Individuals were taught the anal self-examination and anal companion examination (ASE/ACE). Then, a clinician performed a digital anal rectal examination (DARE) before participants conducted the ASE or ACE. The sensitivity, specificity and concordance of the ASE/ACE to detect an abnormality were measured along with factors associated with ASE/ACE and DARE concordance.
Findings: Among 714 enrolled individuals, the median age was 40 years (interquartile range, 32-54), 36.8% (259/703) were living with HIV, and 47.0% (334/710), 23.4% (166/710), and 23.0% (163/710) were non-Hispanic white, non-Hispanic Black, and Hispanic, respectively. A total of 94.1% (671/713) identified as cisgendered men, and 5.9% (42/713) as gender minorities. A total of 658 participants completed an ASE and 28 couples (56 partners) completed an ACE. Clinicians detected abnormalities in 34.3% (245/714) of individuals. The abnormalities were a median of 3 mm in diameter. Sensitivity and specificity of the ASE/ACE was 59.6% (95% CI 53.5-65.7%) and 80.2% (95% CI 76.6-83.8%), respectively. Overall concordance was 0.73 (95% CI 0.70-0.76) between ASE/ACE and DARE and increased with increasing anal canal lesion size (p = 0.02). Concordance was lower when participants were older and received ASE/ACE training from a lay person rather than a clinician.
Interpretation: Sexual minority men/transgender women may self-detect SCCA when malignant lesions are much smaller than the current mean dimension at presentation of ≥30 mm.
Funding: National Cancer Institute.
| Errataetall: | |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Lancet regional health. Americas - 31(2024) vom: 04. März, Seite 100704 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nyitray, Alan G [VerfasserIn] |
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| Links: |
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| Themen: |
Anal canal |
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| Anmerkungen: |
Date Revised 18.03.2024 published: Electronic-eCollection UpdateOf: medRxiv. 2023 Oct 19;:. - PMID 37905024 Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.lana.2024.100704 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369299272 |
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| 100 | 1 | |a Nyitray, Alan G |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The accuracy of anal self- and companion exams among sexual minority men and transgender women |b a prospective analysis |
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| 500 | |a Date Revised 18.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a UpdateOf: medRxiv. 2023 Oct 19;:. - PMID 37905024 | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024 The Author(s). | ||
| 520 | |a Background: Squamous cell carcinoma of the anus (SCCA) annual incidence among sexual minority men with and without HIV is 85/100,000 and 19/100,000 persons, respectively, which is significantly higher than the overall incidence (2/100,000). Incidence may also be higher in transgender women. Since SCCA tumours average ≥30 mm at diagnosis, we assessed the accuracy of individuals to self-detect smaller anal abnormalities | ||
| 520 | |a Methods: Using convenience sampling, the study enrolled sexual minority men and transgender women, aged 25-81 years, in Chicago, Illinois and Houston, Texas, USA, during 2020-2022. Individuals were taught the anal self-examination and anal companion examination (ASE/ACE). Then, a clinician performed a digital anal rectal examination (DARE) before participants conducted the ASE or ACE. The sensitivity, specificity and concordance of the ASE/ACE to detect an abnormality were measured along with factors associated with ASE/ACE and DARE concordance | ||
| 520 | |a Findings: Among 714 enrolled individuals, the median age was 40 years (interquartile range, 32-54), 36.8% (259/703) were living with HIV, and 47.0% (334/710), 23.4% (166/710), and 23.0% (163/710) were non-Hispanic white, non-Hispanic Black, and Hispanic, respectively. A total of 94.1% (671/713) identified as cisgendered men, and 5.9% (42/713) as gender minorities. A total of 658 participants completed an ASE and 28 couples (56 partners) completed an ACE. Clinicians detected abnormalities in 34.3% (245/714) of individuals. The abnormalities were a median of 3 mm in diameter. Sensitivity and specificity of the ASE/ACE was 59.6% (95% CI 53.5-65.7%) and 80.2% (95% CI 76.6-83.8%), respectively. Overall concordance was 0.73 (95% CI 0.70-0.76) between ASE/ACE and DARE and increased with increasing anal canal lesion size (p = 0.02). Concordance was lower when participants were older and received ASE/ACE training from a lay person rather than a clinician | ||
| 520 | |a Interpretation: Sexual minority men/transgender women may self-detect SCCA when malignant lesions are much smaller than the current mean dimension at presentation of ≥30 mm | ||
| 520 | |a Funding: National Cancer Institute | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anal canal | |
| 650 | 4 | |a Anus neoplasms | |
| 650 | 4 | |a Digital anal rectal examination | |
| 650 | 4 | |a Early detection of cancer | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Homosexuality | |
| 650 | 4 | |a Male | |
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| 700 | 1 | |a Chiao, Elizabeth Y |e verfasserin |4 aut | |
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| 700 | 1 | |a Kerman, Jared |e verfasserin |4 aut | |
| 700 | 1 | |a Schneider, John A |e verfasserin |4 aut | |
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| 700 | 1 | |a Hwang, Lu-Yu |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Derek |e verfasserin |4 aut | |
| 700 | 1 | |a Hazra, Aniruddha |e verfasserin |4 aut | |
| 700 | 0 | |a Prevent Anal Cancer Palpation Study Team |e verfasserin |4 aut | |
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