New Anal Dysplasia Clinic aims to prevent anal cancer
UI Health Care’s new Anal Dysplasia Clinic screens and treats people who are at increased risk for HPV-related anal dysplasia by using an approach similar to the one that virtually eliminated cervical cancer in the United States: identify abnormal cells early and treat them before they become cancerous.
The clinic is the first in Iowa to use high-resolution anoscopy (HRA) to examine the anal canal directly for signs of abnormal cells caused by anal dysplasia, a condition that is generally more prevalent in LGBTQ patients but can affect anyone who has been infected with human papillomavirus (HPV).
“Just as HPV can infect the cervix and lead to cervical cancer, HPV can also infect the anus and potentially lead to cancer,” says Nicole Nisly, MD, co-director of the new clinic. “The goal of the Anal Dysplasia Clinic is to screen and treat patients who are at risk for HPV-related precancerous lesions of the anus to prevent suffering and loss of life.”
Because the condition often has no symptoms, people who have anal dysplasia may not know they have it until it has become cancerous, so getting screened is crucial for anyone who is at risk. That includes men who have sex with men, people of any gender who regularly have unprotected anal sex, anyone who has tested positive for HIV, anyone who has had an HPV infection in the genital or anal area, and people who take medications that weaken the immune system.
Screening begins with an anal Pap test. If the Pap test finds abnormal cells, the patient is referred for HRA, a direct examination using a high-magnification colposcope specially equipped for use in the anal canal. UI gastroenterologist Yehudith Assouline-Dayan, MD, co-director of the new clinic, is trained to perform HRA to diagnose and treat anal dysplasia. Treatment options for lesions identified include cauterization or a topical cream.
While the screening procedure for anal dysplasia is similar to the procedure that has worked so well in the prevention of cervical cancer, anal dysplasia screening is relatively rare.
“Until recently, few providers were screening high-risk people for HPV in the anus,” Nisly says. “But in the LGBTQ Clinic we’ve found that when we do anal Pap tests in high-risk people, we are identifying quite a number of abnormal anal Paps that would benefit from high-resolution anoscopy, which until now was not available in Iowa.”
The new clinic will also engage in outreach and research to create awareness of the importance of screening for anal dysplasia.
“We will be talking to providers who normally perform Pap tests, like primary care physicians, but we’ll also be educating specialists who take care of patients who could be at risk,” Nisly says. “There has been very little research into this treatment, so another one of our goals is to participate in research on the benefits of screening, early detection, and treatment of HPV infection in the anus.”
She compares anal dysplasia screening to the work that led to successful prevention of cervical cancer.
“In the 1950s and 1960s people said there wasn’t enough data to support doing a Pap test,” Nisly says. “But look how far we’ve come. We’ve demonstrated that, yes, if you do a Pap, you will save women’s lives. That’s what prevention is all about.”
The new UI Health Care Anal Dysplasia Clinic is located on Level 4 at UI Health Care–Iowa River Landing in Coralville. It’s the only clinic in Iowa to offer high-resolution anoscopy (HRA).
For anal Pap screening tests, patients can be referred by their providers or self-refer to Nicole Nisly, MD, or Susan Kaliszewski, PA-C.
People with abnormal anal Pap tests can be referred by their medical providers for HRA to Yehudith Assouline-Dayan, MD.
To schedule an appointment, call 1-319-467-2000.