Health care provider characteristics associated with anal cancer screening in an urban academic medical system in the United States

Abstract

Background

New guidelines recommend anal cancer screening for priority populations with increased likelihoods of anal cancer including people with a history of HIV, gynecologic cancers, condyloma acuminata, and solid organ transplantation. However, little is known about U.S.-based screening practices prior to these guidelines.

Methods

We examined outpatient clinical encounters between 01/01/2015 and 08/01/2022 and analyzed provider characteristics and screening behaviors in an urban medical system in Boston, U.S. We used chi-squared tests and logistic regression to identify provider factors associated with anal cancer screening.

Results

Of 1098 providers, 48.5% completed at least one screening, including 93.8% (n = 75/80) of infectious disease (ID) providers, 54.6% (n = 372/681) of primary care providers (PCPs), and 28.3% (n = 41/145) of obstetrician/gynecologists (OBGYNs) (p < 0.001). Annual screening of priority populations was most common among providers trained in high-resolution anoscopy (19.8%–27.9% screened), and less common among ID providers (4.4%–8.7%), PCPs (0.4%–1.4%), and OBGYNs (0.1%–0.8%). In multivariate analysis, providers treating proportionately more cisgender women (adjusted odds ratio [aOR] = 0.988; 95% confidence interval [CI] 0.982–0.995), more non-white patients (aOR = 0.984; 95% CI 0.976–0.992), or fewer people with HIV were less likely to be screeners.

Conclusions

Most providers caring for priority populations did not complete anal cancer screenings, and annual screening levels were low across disciplines. Strategies are needed to optimize anal cancer screening practices, particularly for patients who are HIV-negative, non-white, and cisgender women.