Screening for Anal Cancer in Women With High-grade Vulvar Dysplasia or Vulvar Cancer.
Screening for Anal Cancer in Women With High-grade Vulvar Dysplasia or Vulvar Cancer.
Almost half of all women will develop an HPV infection in their lifetime. While most
 infections are naturally asymptomatic or cleared by the immune system, some persist and can
 lead to the development of cervical, vulvar, or anal lesions and eventually cancer. Screening
 regimens for these lesions are currently only in place for the cervix through regular Pap
 tests. These Pap tests usually involve an examination of the vulva -however, no screening
 procedures exist for anal cancer for women. Several studies have suggested that women with
 existing gynecological lesions are more likely to develop anal lesions and anal cancer. Here
 the investigators propose a multi-center study which seeks to screen for and treat anal
 cancer in women over the age of 40 with vulvar lesions and a stable immune system. The
 investigators will achieve this through performing anal Pap smears on eligible women and
 conducting High Resolution Anoscopy (HRA) and appropriate treatment procedures on those with
 abnormal anal cells. With enough evidence, there may be an indication to establish regular
 anal cancer screening measures in this potentially underserved population.

 Hypothesis: The investigators hypothesize that at least 40% of women with vulvar cancer or
 VIN2/3 will have abnormal anal cytology. 35% of the population will be hrHPV DNA positive and
 11% will additionally have AIN2/3. This prospective study may lay the groundwork for routine
 anal screening regimens in Ontario and help shift health policy to treat this population.
Inclusion Criteria:

 -  Women age ≥ 40

 -  Previous diagnosis of VIN 2/3 or vulvar

 Exclusion Criteria:

 -  Women with a previous diagnosis of cancer aside from basal cell carcinoma of the skin,
 cervical cancer, or vulvar cancer

 -  Women who are HIV positive

 -  Women currently taking immunosuppressant medication

 -  Women who have had a previous hysterectomy