Current practices in HPV-related anogenital neoplasia care in Europe - a survey analysis

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BACKGROUND: Human papillomavirus (HPV) is causally related to neoplasia in multiple anogenital zones including anal, vulval, vaginal, and cervical areas in women. Care for anogenital neoplasia involves multiple specialist fields. Women with a history of cervical neoplasia are at increased risk of multiple anogenital neoplasias and second cancers occur in the anogenital zones. Results of a survey on current management practices across Europe are presented. METHODS: A questionnaire was developed by iterative process and circulated amongst specialists in all fields associated with anogenital neoplasia. Data was recorded and analysed using Microsoft Excel/Stata. RESULTS: 316/430 (73.5%) respondents collaborated with colleagues to provide care, but only 27.0% were engaged in full multidisciplinary team meetings (MDT). Second cancers were observed both in the same anatomical zone (56.5%) as well as in different anatomical zones (45.3%) by the respondents. The survey identifies significant variability in clinician workload, experience and screening practices. Low utilisation of high-resolution anoscopy (HRA) by specialists (14.9%) indicate lack of standardisation of practices, though some (12.7%) expressed interest in training in HRA. 24.4% did not offer treatment for anogenital neoplasia, while those who treated utilised multiple modes of treatment. CONCLUSIONS: Recognition of multizonal anogenital neoplasia and the risk of second cancers, and new data on successful treatment of anal neoplasia have led to the assessment of expertise amongst Europe's specialists. Enhanced HRA training, improved guidelines and robust follow-up protocols are essential to optimising care. A concerted effort is needed to align professional development, workload standards and clinical practices across Europe.