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Invited Commentary |

Considering Standards of Care for Anal Cancer

James Fleshman, MD1,2
[+] Author Affiliations
1Department of Surgery, Baylor University Medical Center, Dallas, Texas
2Department of Surgery, Texas A&M Health Sciences College of Medicine, Dallas
JAMA Surg. 2015;150(6):569. doi:10.1001/jamasurg.2015.48.
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This Invited Commentary raises questions regarding the routine use of high-resolution anoscopy as a screening tool for anal dysplasia and cancer.

High-resolution anoscopy (HRA) has become a term that induces fear and trepidation in the hearts of most colorectal surgeons. There is a certain sinking feeling when one considers the time and effort that will be expended, with little return, when the standard of care becomes the routine use of HRA for all human immunodeficiency virus–positive patients. This time and effort are for a 0.131% risk of anal cancer in the highest-risk group—men having sex with men who have human immunodeficiency virus. In fact, colorectal surgeons observe most of these individuals on a regular basis in the office if they have condyloma or symptoms of anal disease. Anoscopy without high resolution actually reveals most anal lesions that cause symptoms. The time spent performing HRA compared with routine anoscopy may discourage most health care professionals from using HRA, except those focused on high-grade squamous intraepithelial lesions (HSIL) and human immunodeficiency as a specialty.

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