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

• Authors: Jessica Wells, Emory University; Lisa Flowers, Emory University; Sudeshna Paul, Emory University; Minhly Nguyen, Emory University; Anjali Sharma, Albert Einstein College of Medicine; Marcia Holstad, Emory University
• Journal Title: JOURNAL OF CANCER EDUCATION
• Volume: Volume 35, Number 3
• Publisher: SPRINGER | 2020-06-01, Pages 606-615
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s13187-019-01503-8
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Oncology; Education, Scientific Disciplines; Public, Environmental & Occupational Health; Education & Educational Research; Anal cancer; Knowledge; Anal Pap test; Women; SQUAMOUS INTRAEPITHELIAL LESIONS; HUMAN-PAPILLOMAVIRUS; CERVICAL-CANCER; PREVALENCE; INFECTION; PREVENTION; NEOPLASIA; VACCINE

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.