BACKGROUND: Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results-namely high-risk human papillomavirus (HPV) infection and cytohistopathology-predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer. METHODS: We did a systematic review of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL. FINDINGS: Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16·5, 95% CI 14·2-19·2, p<0·0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4·4, 3·7-5·3, p<0·0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14·1, 11·1-17·9, p<0·0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12·9, 95% CI 6·7-24·8, p<0·0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2·3, 1·6-3·4, p<0·0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23·1, 9·4-57·0, p<0·0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3·6, 2·5-5·3, p<0·0001). Prevalence of HPV16-positive anal HSIL was 23-25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women). INTERPRETATION: HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women. FUNDING: International Agency for Research on Cancer.

Aviano Cancer Center Aviano Italy

Chronic Viral Illness Service McGill University Health Centre and Department of Family Medicine McGill University Montreal QC Canada

David Geffen School of Medicine University of California Los Angeles CA USA

Department of Endocrinology and Reproductive Medicine IE3M Groupe Hospitalier Pitié Salpêtrière Assistance Publique Hôpitaux de Paris Paris France

Department of Family and Community Medicine University of California San Francisco School of Medicine San Francisco CA USA

Department of Gynecology and Obstetrics General University Hospital and 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Gynecology of the Federal University of São Paulo São Paulo Brazil

Department of Infectious Diseases Infectious Diseases Research and Prevention GGD Amsterdam Netherlands

Department of Medical Microbiology University of Zimbabwe College of Health Sciences Parirenyatwa Hospital premises Harare Zimbabwe

Department of Molecular Medicine Sapienza University of Rome Rome Italy

Division of Epidemiology and Biostatistics ICMR National AIDS Research Institute Indian Council of Medical Research Pune India

Division of HIV AIDS Prevention Epidemiology Research Team Centers for Disease Control and Prevention Atlanta GA USA

Division of Infectious Disease University of South Florida Tampa FL USA

Dr Hideyo Noguchy Center of Regional Investigations Autonomous University of Yucatán Mérida Yucatán México

Health Sciences Center Federal University of Espírito Santo Vitória Brazil

Infectious Diseases Service University Hospital Virgen de las Nieves Granada Spain

Institute of Infectious Disease and Molecular Medicine University of Cape Town Cape Town South Africa; Department of Pathology Division of Medical Virology University of Cape Town Cape Town South Africa; Centre for HIV and STIs National Institute for Communicable Diseases National Health Laboratory Service Johannesburg South Africa; South African Medical Research Council Gynaecological Cancer Research Centre University of Cape Town Cape Town South Africa

Instituto Nacional de Infectologia Evandro Chagas Fiocruz Rio de Janeiro Brazil

International Agency for Research on Cancer Lyon France

International Agency for Research on Cancer Lyon France; National Cancer Center National Clinical Research Center for Cancer and Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia

Mount Sinai West and St Luke's Hospitals New York NY USA

National Cancer Institute National Institutes of Health Bethesda MD USA

Obstetrics and Gynecology and Medicine The Warren Alpert Medical School of Brown University Providence RI USA

Proyecto Epidemiológico Guanacaste Fundación INCIENSA San José Costa Rica

Public Health Epidemiology Head Department Public Health Institute of Tropical Medicine Antwerp Belgium

Radboud University Nijmegen Medical Centre Department of Urology Nijmegen Netherlands

Research Institute of Life and Health Sciences School of Medicine University of Minho Braga Portugal; 3B's Research Group Portugal Government Associate Laboratory Braga Portugal; Laboratory of Medical Investigation 14 Department of Pathology Faculty of Medicine University of São Paulo São Paulo Brazil; Teaching and Research Institute Molecular Oncology Research Center Barretos Cancer Hospital Pio XII Foundation Barretos Brazil

Samuel Oschin Comprehensive Cancer Institute Cedars Sinai Medical Center Los Angeles CA USA

State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious Diseases School of Public Health Xiamen University Xiamen Fujian China

Thai Red Cross AIDS Research Centre Bangkok Thailand

TREAT Asia amfAR Foundation for AIDS Research Thai Red Cross AIDS Research Centre Bangkok Thailand

University of California San Francisco CA USA

University of Hawaii Cancer Center Honolulu Hawaii USA

University of Puerto Rico Comprehensive Cancer Center Department of Biostatistics and Epidemiology Graduate School of Public Health UPR San Juan Puerto Rico

Weill Cornell Medicine New York NY USA

Women's Healthcare Center Instituto de Medicina Integral Professor Fernando Figueira Recife PE Brazil; Cytopathology Division Public Health Laboratory of the State of Pernambuco Recife PE Brazil

Comment In

Lancet Infect Dis. 2019 Aug;19(8):799-800. doi: 10.1016/S1473-3099(19)30296-8. PubMed

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