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Early impact and performance characteristics of an established anal dysplasia screening program: program evaluation considerations.

Mathews C, Caperna J, Cachay ER, Cosman B - Open AIDS J (2007)

Bottom Line: The percent of patients with IAC requiring chemoradiation decreased from 90.9% to 70.6% (p=0.36).There was a significant improvement in cyto-histologic agreement at HRA with increasing operator experience (r=0.92, p=0.025).The median interval between the last cytology and the last clinic visit was 207 days. (1) The overall IR of IAC did not decline in the screening era and was higher than previous estimates for HIV cohorts; (2) stage shift to IAC of more favorable prognosis is a reasonable screening goal; (3) HRA accuracy varied by provider experience; (4) because of delay in access to HRA, digital rectal exam should be combined with cytology screening to detect palpable disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of California, San Diego, 200 West Arbor Drive. San Diego, CA 92103-8681, USA. cmathews@ucsd.edu

ABSTRACT

Background: Screening for invasive anal cancer and its precursors is being increasingly advocated as a response to increasing incidence among HIV-infected persons. We implemented a comprehensive screening program in 2001 and report our early experience to inform monitoring and evaluation of such programs. Our research aims were: (1) to estimate incidence of and mortality from invasive anal cancer (IAC) before (1995-2000) and after (2001-2005) screening program implementation and (2) to examine potential screening program quality indicators.

Methods: The study cohort included all patients under care for HIV infection at UCSD Owen Clinic between 1995-2005. Person-time incidence rates (IR) and case survival of IAC were estimated for the pre-screening (1995-2000) and post-screening (2001-2005) periods. High resolution anoscopy (HRA) operator accuracy was estimated by kappa agreement between cyto-histologic comparisons. Program quality indicators included: (1) screening coverage; (2) percent technically unsatisfactory cytology smears; (3) time between 1st abnormal cytology and 1st HRA; and (4) time between last clinic visit and last cytology.

Results: 28 cases of IAC and 13,411 person-years were observed between 1995-2005. IRs (95% CI) pre-screening and post-screening were 199 and 216 per 100,000 person-years, respectively. There was no routine treatment of high grade squamous intraepithelial lesions (HSIL) during the study period. The percent of patients with IAC requiring chemoradiation decreased from 90.9% to 70.6% (p=0.36). There was a significant improvement in cyto-histologic agreement at HRA with increasing operator experience (r=0.92, p=0.025). Screening coverage was 73% of the target population. Among 14 providers, the percent unsatisfactory cytology smears averaged 27% but varied from 0 - 62%. The median time from 1st abnormal cytology to 1st HRA was 258 days. The median interval between the last cytology and the last clinic visit was 207 days.

Conclusion: (1) The overall IR of IAC did not decline in the screening era and was higher than previous estimates for HIV cohorts; (2) stage shift to IAC of more favorable prognosis is a reasonable screening goal; (3) HRA accuracy varied by provider experience; (4) because of delay in access to HRA, digital rectal exam should be combined with cytology screening to detect palpable disease.

No MeSH data available.


Related in: MedlinePlus

Agreement between anal cytology and anal biopsy histopathology.
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Figure 4: Agreement between anal cytology and anal biopsy histopathology.

Mentions: Six clinicians performed a total of 1763 high resolution anoscopies between 2001 - 2005. The median number of procedures per operator was 176, varying from 16 – 886. Overall chance-corrected cyto-histologic agreement (kappa) was 0.29, but varied among operators from 0.09 – 0.34. In contrast to what was observed for the technical unsatisfactory cytology indicator, there was a definite relationship (Fig. 4) between operator experience and kappa cyto-histologic agreement (Spearman rho 0.89, p= 0.02).


Early impact and performance characteristics of an established anal dysplasia screening program: program evaluation considerations.

Mathews C, Caperna J, Cachay ER, Cosman B - Open AIDS J (2007)

Agreement between anal cytology and anal biopsy histopathology.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2530895&req=5

Figure 4: Agreement between anal cytology and anal biopsy histopathology.
Mentions: Six clinicians performed a total of 1763 high resolution anoscopies between 2001 - 2005. The median number of procedures per operator was 176, varying from 16 – 886. Overall chance-corrected cyto-histologic agreement (kappa) was 0.29, but varied among operators from 0.09 – 0.34. In contrast to what was observed for the technical unsatisfactory cytology indicator, there was a definite relationship (Fig. 4) between operator experience and kappa cyto-histologic agreement (Spearman rho 0.89, p= 0.02).

Bottom Line: The percent of patients with IAC requiring chemoradiation decreased from 90.9% to 70.6% (p=0.36).There was a significant improvement in cyto-histologic agreement at HRA with increasing operator experience (r=0.92, p=0.025).The median interval between the last cytology and the last clinic visit was 207 days. (1) The overall IR of IAC did not decline in the screening era and was higher than previous estimates for HIV cohorts; (2) stage shift to IAC of more favorable prognosis is a reasonable screening goal; (3) HRA accuracy varied by provider experience; (4) because of delay in access to HRA, digital rectal exam should be combined with cytology screening to detect palpable disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of California, San Diego, 200 West Arbor Drive. San Diego, CA 92103-8681, USA. cmathews@ucsd.edu

ABSTRACT

Background: Screening for invasive anal cancer and its precursors is being increasingly advocated as a response to increasing incidence among HIV-infected persons. We implemented a comprehensive screening program in 2001 and report our early experience to inform monitoring and evaluation of such programs. Our research aims were: (1) to estimate incidence of and mortality from invasive anal cancer (IAC) before (1995-2000) and after (2001-2005) screening program implementation and (2) to examine potential screening program quality indicators.

Methods: The study cohort included all patients under care for HIV infection at UCSD Owen Clinic between 1995-2005. Person-time incidence rates (IR) and case survival of IAC were estimated for the pre-screening (1995-2000) and post-screening (2001-2005) periods. High resolution anoscopy (HRA) operator accuracy was estimated by kappa agreement between cyto-histologic comparisons. Program quality indicators included: (1) screening coverage; (2) percent technically unsatisfactory cytology smears; (3) time between 1st abnormal cytology and 1st HRA; and (4) time between last clinic visit and last cytology.

Results: 28 cases of IAC and 13,411 person-years were observed between 1995-2005. IRs (95% CI) pre-screening and post-screening were 199 and 216 per 100,000 person-years, respectively. There was no routine treatment of high grade squamous intraepithelial lesions (HSIL) during the study period. The percent of patients with IAC requiring chemoradiation decreased from 90.9% to 70.6% (p=0.36). There was a significant improvement in cyto-histologic agreement at HRA with increasing operator experience (r=0.92, p=0.025). Screening coverage was 73% of the target population. Among 14 providers, the percent unsatisfactory cytology smears averaged 27% but varied from 0 - 62%. The median time from 1st abnormal cytology to 1st HRA was 258 days. The median interval between the last cytology and the last clinic visit was 207 days.

Conclusion: (1) The overall IR of IAC did not decline in the screening era and was higher than previous estimates for HIV cohorts; (2) stage shift to IAC of more favorable prognosis is a reasonable screening goal; (3) HRA accuracy varied by provider experience; (4) because of delay in access to HRA, digital rectal exam should be combined with cytology screening to detect palpable disease.

No MeSH data available.


Related in: MedlinePlus