Blind Spots, Opportunities, and Hope for Anal Neoplasia: Lessons learned at the IANS Meeting

June 24, 2025

Posted By: Amanda Olson in Career Development,

I had the tremendous opportunity to travel to London, UK June 6-8, 2025, to attend the International Anal Neoplasia Society Conference. I am a clinical member of this society and I participate on the patient outreach committee.

I was honored to have an abstract accepted for poster titled: PELVIC HEALTH & SEX AFTER CANCER: A SYSTEMATIC REVIEW OF DILATORS AND PELVIC THERAPY IN THE MANAGEMENT OF SEXUAL ISSUES FOLLOWING CANCER TREATMENT IN WOMEN

Additionally, I was a speaker, and delivered a 45 minute talk titled Blind Spots, Opportunities, and Hope, on the role of pelvic physical therapy and dilator use for the management of sequelae of anal cancer treatments.

I had many international physicians approach me after my presentation to thank me for highlighting this blind spot in their practice, and to let me know that they would be changing their practice patterns. I am also proud to say that there were many American providers at the conference, and several made comments in the question period of my discussion explaining how thankful they were for the pelvic therapists that they already refer to.

Some important takeaways from this scientific meeting include the importance of awareness about how the disease spreads, and in screening. The link between anal neoplasia and Human papillomavirus (HPV) is now well known. HPV is a common sexually transmitted infection, and certain high-risk strains of HPV, especially HPV types 16 and 18, are strongly associated with anal intraepithelial neoplasia (AIN) and anal cancer. HPV infects the squamous epithelium of the anal canal, particularly at the transformation zone, where columnar and squamous cells meet, similar to the cervix. This can occur through vaginal or anal penetration.

Persistent infection with high-risk HPV strains can lead to cellular dysplasia, which may progress over time and eventually can lead to invasive anal cancer if left undetected and untreated.

Some populations are at significantly increased risk for persistent HPV infection and progression to anal neoplasia. This includes people with HIV (due to immune suppression), men who have sex with men (MSM), and women with a history of cervical, vulvar, or vaginal neoplasia. Additionally, it has been found in organ transplant recipients and people with chronic immunosuppression.

Of upmost importance is the realization that anal cancer is increasing in incidence. While rare compared to other cancers, anal cancer rates are rising, especially among high-risk populations. It often presents late with symptoms like bleeding or pain, making early screening even more crucial.

Furthermore, there are similarities to cervical cancer prevention techniques. As with cervical cancer, screening for anal dysplasia offers a chance to intervene early, using techniques including digital anal rectal examination (DARE), High-resolution anoscopy (HRA), and biopsy and treatment of dysplasia if found.

Studies show that routine screening and treatment of High-Grade Squamous Intraepithelial Lesion (HSIL) significantly reduces the risk of progression to anal cancer. The ANCHOR study (2022) showed that treatment of HSIL in people with HIV reduced progression to cancer by more than 50%, supporting the value of screening and intervention. Many of the physicians and researchers who participated in the ANCHOR study were present at the conference and emphasized the importance of screening in the HIV population.

All things considered, it is important for pelvic physical therapists to be aware that HPV is the primary cause of anal dysplasia and cancer. High-risk groups should undergo routine screening, especially if immunocompromised. Early detection and treatment of high-grade lesions prevent cancer. Screening saves lives, just as Pap smears transformed cervical cancer outcomes.