Skip to main content

Advertisement

SpringerLink
Log in

Knowledge of Anal Cancer, Anal Cancer Screening, and HPV in HIV-Positive and High-Risk HIV-Negative Women

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

The incidence of anal cancer in HIV-positive women is a growing public health concern where they have a 7.8-fold increased risk for anal cancer than women in the general population. We examined knowledge of anal cancer, anal cancer screening, and HPV in HIV-positive women and high-risk HIV-negative women. Women were recruited from the Women’s Interagency HIV Study and completed an adapted Knowledge of Anal Cancer and HPV Scale. Correlations among anal cancer knowledge and sociodemographic and risk factors were assessed using Pearson’s or Spearman’s rho r test. Student’s t test or chi-square tests identified significant differences between groups by HIV status or risk factors. Among 155 women, 72% (n = 113) correctly identified the purpose of an anal Pap test. However, only 42% (n = 65) identified HIV as a risk factor for anal cancer. HIV-positive women were more knowledgeable about anal cancer than high risk HIV-negative women (t = 2.104, p = .037). Women with a history of an abnormal cervical Pap test (t = 2.137, p = .034), younger age (t = 3.716, p = .000), reported history of anal sex (t = 3.284, p = .001), some college education or higher (t = −2.005, p = .047), and non-smokers (t = 2.425, p = .016) were significantly more knowledgeable about HPV. Although most women were knowledgeable about anal cancer, many women could not identify important risk factors for anal cancer, such as HIV infection. Patient educational interventions tailored to HIV-positive women are warranted to improve knowledge and awareness of risk for anal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Silverberg MJ, Lau B, Justice AC, Engels E, John Gill M, Goedert JJ, Kirk GD et al (2012) Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clin Infect Dis 54(7):1026–1034

    Article  PubMed  PubMed Central  Google Scholar 

  2. Frisch M, Biggar RJ, Goedert JJ (2000) Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst 92(18):1500–1510

    Article  CAS  PubMed  Google Scholar 

  3. Chin-Hong PV, Palefsky JM (2005) Human papillomavirus anogenital disease in HIV-infected individuals. Dermatol Ther 18(1):67–76

    Article  PubMed  Google Scholar 

  4. Palefsky JM a, Holly EA, Ralston ML, Da Costa M, Greenblatt RM (2001) Prevalence and risk factors for anal human papillomavirus infection in human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women. J Infect Dis 183(3):383–391

    Article  CAS  PubMed  Google Scholar 

  5. Kojic EM, Cu-Uvin S, Conley L, Bush T, Onyekwuluje J, Swan DC, Unger ER, Henry K, Hammer JH, Overton ET (2011) Human papillomavirus infection and cytologic abnormalities of the anus and cervix among HIV-infected women in the study to understand the natural history of HIV/AIDS in the era of effective therapy (the SUN study). Sex Transm Dis 38(4):253–259

    PubMed  Google Scholar 

  6. De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S (2009) Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta analysis. Int J Cancer 124(7):1626–1636

    Article  CAS  PubMed  Google Scholar 

  7. Palefsky JM (2012) Practising high-resolution anoscopy. Sex Health 9(6):580–586

    Article  PubMed  Google Scholar 

  8. Moscicki AB, Darragh TM, Berry-Lawhorn JM, Roberts JM, Khan MJ, Boardman LA, Chiao E et al (2015) Screening for anal cancer in women. J Low Genit Tract Dis 19(3 Suppl 1):S27–S42. https://doi.org/10.1097/lgt.0000000000000117

    Article  PubMed  Google Scholar 

  9. Wells JS, Holstad MM, Thomas T, Bruner DW (2014) An integrative review of guidelines for anal cancer screening in HIV-infected persons. AIDS Patient Care STDs 28(7):350–357

    Article  PubMed  Google Scholar 

  10. New York State Department of Health (2007) Primary care approach to the HIV-infected patient. New York State Department of Health, New York

    Google Scholar 

  11. Palefsky J, Berry JM, Jay N (2012) Anal cancer screening. Lancet Oncol 13(7):e279–e280

    Article  PubMed  Google Scholar 

  12. Fylan F (1998) Screening for cervical cancer: a review of women’s attitudes, knowledge, and behaviour. Br J Gen Pract 48(433):1509–1514

    PubMed  PubMed Central  CAS  Google Scholar 

  13. Massad LS, Evans CT, Wilson TE, Goderre JL, Hessol NA, Henry D, Colie C, Strickler HD, Levine AM, Watts DH, Weber KM (2010) Knowledge of cervical cancer prevention and human papillomavirus among women with HIV. Gynecol Oncol 117(1):70–76. https://doi.org/10.1016/j.ygyno.2009.12.030.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wigfall LT, Bynum SA, Brandt HM, Hebert JR (2016) HPV vaccine awareness and knowledge among women living with HIV. J Cancer Educ 31(1):187–190. https://doi.org/10.1007/s13187-015-0943-8

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Pitts MK, Fox C, Willis J, Anderson J (2007) What do gay men know about human papillomavirus? Australian gay men’s knowledge and experience of anal cancer screening and human papillomavirus. Sex Transm Dis 34(3):170–173

    Article  PubMed  Google Scholar 

  16. Catania JA, Kegeles SM, Coates TJ (1990) Towards an understanding of risk behavior: an AIDS risk reduction model (ARRM). Health Educ Q 17(1):53–72

    Article  CAS  PubMed  Google Scholar 

  17. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, Carter JJ, Porter PL, Galloway DA, McDougall JK (2004) Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 101(2):270–280. https://doi.org/10.1002/cncr.20365

    Article  PubMed  Google Scholar 

  18. Hessol NA, Holly EA, Efird JT, Minkoff H, Schowalter K, Darragh TM, Burk RD, Strickler HD, Greenblatt RM, Palefsky JM (2009) Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women. Aids 23(1):59–70

    Article  PubMed  PubMed Central  Google Scholar 

  19. Holly EA, Ralston ML, Darragh TM, Greenblatt RM, Jay N, Palefsky JM (2001) Prevalence and risk factors for anal squamous intraepithelial lesions in women. J Natl Cancer Inst 93(11):843–849

    Article  CAS  PubMed  Google Scholar 

  20. Frisch M, Glimelius B, van den Brule AJ, Wohlfahrt J, Meijer CJ, Walboomers JM, Goldman S, Svensson C, Adami HO, Melbye M (1997) Sexually transmitted infection as a cause of anal cancer. N Engl J Med 337(19):1350–1358. https://doi.org/10.1056/nejm199711063371904

    Article  PubMed  CAS  Google Scholar 

  21. Bacon MC, von Wyl V, Alden C, Sharp G, Robison E, Hessol N, Gange S, Barranday Y, Holman S, Weber K, Young MA (2005) The Women’s Interagency HIV study: an observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol 12(9):1013–1019. https://doi.org/10.1128/cdli.12.9.1013-1019.2005.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Barkan SE, Melnick SL, Preston-Martin S, Weber K, Kalish LA, Miotti P, Young M, Greenblatt R, Sacks H, Feldman J (1998) The women’s interagency HIV study. Epidemiology 9(2):117–125

    Article  CAS  PubMed  Google Scholar 

  23. Massad LS, Evans CT, Weber KM, Goderre JL, Hessol NA, Henry D, Colie C, Strickler HD, Watts DH, Wilson TE (2010) Changes in knowledge of cervical cancer prevention and human papillomavirus among women with human immunodeficiency virus. Obstet Gynecol 116(4):941–947. https://doi.org/10.1097/AOG.0b013e3181f2dbae

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hild-Mosley KA, Patel DM, Markwell S, Massad LS (2009) Knowledge of cervical cancer screening, human papillomavirus, and HPV vaccine among Midwestern gynecology patients. J Low Genit Tract Dis 13(4):200–206

    Article  Google Scholar 

  25. Six C, Heard I, Bergeron C, Orth G, Poveda JD, Zagury P, Cesbron P et al (1998) Comparative prevalence, incidence and short-term prognosis of cervical squamous intraepithelial lesions amongst HIV-positive and HIV-negative women. AIDS 12(9):1047–1056

    Article  CAS  PubMed  Google Scholar 

  26. Sichanh C, Quet F, Chanthavilay P, Diendere J, Latthaphasavang V, Longuet C, Buisson Y (2014) Knowledge, awareness and attitudes about cervical cancer among women attending or not an HIV treatment center in Lao PDR. BMC Cancer 14:161. https://doi.org/10.1186/1471-2407-14-161

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I – WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR000454 (Atlanta CTSA), and P30-AI-050410 (UNC CFAR).

U01-AI-103408 (Atlanta WIHS) and UL1-TR000454 (Atlanta CTSA)

U01-AI-035004 (Bronx WIHS)

We would like to acknowledge the National Program of Cancer Registries of the Centers for Disease Control and Prevention (CDC) for the funds that helped support the collection and availability of the cancer registry data and thank the following state cancer registries for their help: AL, CA, FL, GA, IL, MD, MS, NY, NC, and VA. The authors assume full responsibility for analyses and interpretations of these data.

Author information

Authors and Affiliations

  1. Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA

    Jessica S. Wells, Sudeshna Paul & Marcia Holstad

  2. Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA

    Lisa Flowers

  3. Grady Ponce De Leon Center, Atlanta, GA, USA

    Lisa Flowers & Minh Ly Nguyen

  4. Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Minh Ly Nguyen

  5. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Anjali Sharma

Authors
  1. Jessica S. Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa Flowers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sudeshna Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minh Ly Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anjali Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcia Holstad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica S. Wells.

Ethics declarations

Approval from the Institutional Review Board of Emory University and research committees at the recruitment site were granted before commencement of enrollment.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wells, J.S., Flowers, L., Paul, S. et al. Knowledge of Anal Cancer, Anal Cancer Screening, and HPV in HIV-Positive and High-Risk HIV-Negative Women. J Canc Educ 35, 606–615 (2020). https://doi.org/10.1007/s13187-019-01503-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-019-01503-8

Keywords

Search

Navigation