An effective screening program for anal cancer prevention relies upon the availability of high resolution anoscopy (HRA).  If HRA is unavailable, secondary screening can be performed with DARE alone. Initial screening including anal swab collection (for cytology and/or hrHPV) should only be performed if HRA is available in the community. The impact of screening on preventing anal cancer will be largely dependent on achieving high compliance with screening recommendations, follow-up treatment, and surveillance.

HRA is similar in principle and practice to colposcopy of the gynecologic tract. It requires significant training and costly equipment. Even among high resource settings, the major challenge to the implementation of anal cancer screening guidelines is that it's limited by the availability of HRA infrastructure for referral of patients with abnormal screening results. It is essential to understand that anal cancer prevention should only be offered if there is sufficient capacity for HRA. In its absence, secondary screening for anal cancer should be offered universally to at-risk populations with a DARE.

Before you start anal cancer screening, explore your local resources of HRA clinics and their capacity. And if you have interest in becoming an HRA provider you can find information on the IANS website iansoc.org.

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