What Are We Waiting for?—Start Screening High-risk Individuals for Anal Cancer Now—Reply

In Reply We thank Terlizzi et al for their comments on our cohort study1 and insightful review of the current literature, which highlights the importance of anal dysplasia screening in high-risk individuals and the subsequent treatment of high-grade lesions to prevent the progression to anal cancer. We agree with their impassioned call to begin screening for and treating high-grade anal dysplasia in at-risk populations to address the alarming rise in anal cancer incidence in the US.2 However, we encourage clinicians to use a shared decision-making model with their patients given the lack of the highest-quality evidence on anal dysplasia screening and treatment,1 which is reflected by the absence of national guidelines on the subject from organizations, such as the US Preventive Services Task Force or the US Centers for Disease Control and Prevention.1 We also agree with Terlizzi et al that it is critical to begin training more clinicians to perform high-resolution anoscopies—analogous to colposcopies—because many communities in the US lack clinicians who are trained to perform these procedures, thereby making it difficult for many patients with abnormal anal cytology results to receive follow-up.

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