Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in the
world. It is currently estimated that 4.5% of all cancers worldwide are attributable to HPV,
representing 630,000 new cases per year. HPV is responsible for more than 98% of
pre-cancerous and cancerous lesions of the cervix and vagina and 88% of anal cancers.
Although prevention of HPV infection has been available since 2007, there are approximately
3000 new cases of cervical cancer in France each year. Women benefit from organized screening
for cervical cancer.
HPV is also responsible for anal cancer in more than 90% of cases, mostly caused by HPV
16/18. Its incidence is lower with 1162 cases in women in 2018 but is increasing strongly
(+88% in women since 1990).
As with cervical cancer, there are precursors to anal cancer: high-grade intraepithelial
lesions. Early diagnosis of these lesions could potentially reduce the incidence of anal
cancer, but there are still few data in the literature. The prevalence of anal carriage in
patients with a history of cervical dysplasia or cervical cancer is estimated in studies to
be 20% with a risk of high grade anal lesions of 8%.
The relative risk of developing anal cancer in women with a history of high-grade cervical
lesions is about 5 per 100,000, 15 per 100,000 for those with a history of cervical cancer,
and 42 and 48 per 100,000 respectively for women with HPV-induced pre-cancer and cancerous
lesions of the vulva.
The different means of cervico-vaginal screening: screening samples: HPV test, cytology, some
biomarkers: double labelling p16/ki67, E6-E7 mRNA and clinical examination with or without
colposcopy (examination of the cervix with a magnifying glass) are used at the gynecological
level but also at the anal level with as examination: simple anuscopy and high resolution
anuscopy. Some scientific societies have established surveillance algorithms for certain risk
groups, but there are no clinical practice recommendations yet for women with a history of
gynecological HPV-induced lesions.
A proctology follow-up protocol for at-risk patients is proposed to patients based on
cervico-vaginal surveillance recommendations and data in the literature, pending clinical
practice guidelines. The frequency of these examinations depends on the patient's age and the
existence of other risk factors for the development of anal HPV lesions. Depending on these
elements, follow-up is proposed every 3 years, 5 years, or annually.
The objective of this work is therefore to propose proctological surveillance to this
population considered at risk, according to age, smear results and HPV test.