Squamous Cell Carcinoma of the Anus (SCCA) is a rare cancer that is heavily associated with high-risk human papillomavirus infection (HRHPV) of the squamocolumnar junction (SCJ) of the anus. Treatment of SCCA ranges from chemotherapy and radiation for early stage cancer, and surgical interventions such as abdominoperineal resection for later stage cancer. Patients who present with late-stage metastatic SCCA have a five-year survival rate of 32%, emphasizing the crucial need for early detection. Given its rarity in the general population (approximately 1 to 2 cases per 100,000 people), screening guidelines to allow for early detection of SCCA have not been fully established, and remains the subject of continuous debate amongst clinicians, researchers, and public health practitioners.
A major challenge in establishing SCCA screening guidelines is slow progression of symptoms. 20-33% of patients diagnosed with SCCA were clinically asymptomatic at the time of their diagnosis. Patients who reported symptoms usually noted mild symptoms, which mimicked ones found in other anal disorders. For instance, early stage cases of SCCA frequently manifest as bleeding in the anus, but in the absence of other serious symptoms, patients and clinicians often assume hemorrhoids as a cause.
As SCCA is a rare disease with that frequently presents with seemingly benign symptoms, if any, few studies have addressed the complexities of concerns in regards to preventive screening of SCCA. Using “Principles and Practice of Screening for Disease” by Wilson and Jungner, this thesis intends to discuss known screening strategies for SCCA and explore knowledge gaps in need of further study before definitive guidelines for SCCA screening can be established.
Wilson and Jungner do not specifically address the issue of SCCA; rather, they provide a framework for establishing guidelines for disease screening. This thesis will examine the current understanding of SCCA gained in literature and will apply them to the ten tenets that Wilson and Jungner uphold as necessary criteria that should be considered in order to craft an appropriate screening methodology for a specific disease. These tenets address issues ranging from the severity of the disease in question, available treatments for the disease, and the economic perspective relating the cost of screening to the cost of treatment and management.
Analysis of the ten tenets of Wilson and Jungner in relation to SCCA has revealed the need for the cancer research community to gain a better understanding of the role of high-grade intraepithelial lesions, which may act as a precursor to the development of SCCA; however, a significant portion of persons afflicted with HSIL have demonstrated the ability to spontaneously clear them. In addition, this thesis identified a need to gain a better understanding of HPV, especially in chronic variants. Further research to develop SCCA screening guidelines should also evaluate and weigh the effectiveness and practicality of different screening techniques; certain techniques such as anal cytology may be easily implemented on a massive scale, but may be less accurate.
Though a rare disease, the progressive yearly increase in incidence (2.2% per year) of SCCA indicates that comprehensive screening guidelines are urgently needed. Using an analysis of a tried and true framework for establishing disease screening guidelines set by Wilson and Jungner, this thesis intends to contribute to the development of a standardized set of screening guidelines for SCCA. In doing so, we hope to allow SCCA to be managed in a manner that minimizes the impact on patients’ quality of life in a cost-effective manner.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43846 |
| Date | 09 February 2022 |
| Creators | Gardner, James Alan |
| Contributors | Stier, Elizabeth, Moussavi, Mina |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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