Cancer Causes & Control

, Volume 30, Issue 6, pp 559–568 | Cite as

Exploring anal self-examination as a screening tool for women at risk for anal cancer: awareness, interest, and barriers to behavioral uptake

  • David A. MoskowitzEmail author
  • Musarrat Rahman
  • Dennis H. Li
Original Paper



Anal cancer is the second most common human-papillomavirus-related cancer in women, with women also at an elevated risk of incidence relative to men. Anal self-examination (ASE) is an efficient way for women to screen between provider visits for potential anal masses. While studied in male populations, no research has explored women’s awareness of the self-test.


In response, 345 women recruited from online advertisements and listservs were surveyed to assess their experiences using health care, history of Pap smears, knowledge of anal cancer, awareness and attitudes surrounding ASEs, and potential educational modalities to promote ASE enactment.


Results indicated the sample failed two key anal cancer knowledge tests (receiving a 68%/100% for risk factors and 61%/100% for signs/symptoms), and only 2.3% of participants had ever heard of ASEs before the survey. Most thought ASEs would be somewhat helpful as a screening tool, but little interest was shown towards future performance. Analyses revealed this disinterest was due to lack of knowledge, perceived discomfort with performing ASEs, and perceived irrelevance of ASEs.


Future interventions should push for a stronger role of providers (e.g., gynecologists) in anal health, education, and screening. Additionally, campaigns should be crafted to promote the ASE as an easy, at-home screening tool that could trigger an early warning for anal disease.


Anal cancer Anal self-examination Cancer screening HPV Women’s sexual health 



We would like to acknowledge the Division of Health Behavior and Community Health at the School of Health Sciences & Practice, New York Medical College, for its funding. We would also like to thank Atticus Ranck and Drs. Barbara Greenberg, Penny Liberatos, Ben Watson, and Jason Ong for their guidance and advice. Special recognition to Dr. Phillip Moskowitz for his medical expertise on this work and for retiring after 43 years of saving lives as a gastroenterologist.


This study was funded by the Department of Public Health at the School of Health Sciences & Practice, New York Medical College.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

A waiver of informed consent was granted by the institutional review board at the New York Medical College (L# 011915).


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David A. Moskowitz
    • 1
    • 2
    Email author
  • Musarrat Rahman
    • 3
  • Dennis H. Li
    • 1
    • 2
  1. 1.Department of Medical Social SciencesFeinberg School of Medicine, Northwestern UniversityChicagoUSA
  2. 2.Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH)Feinberg School of Medicine, Northwestern UniversityChicagoUSA
  3. 3.Department of Public HealthSchool of Health Sciences & Practice, New York Medical CollegeValhallaUSA

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