{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T05:19:42Z","timestamp":1787980782330,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The incidence of anal cancer in older women has risen significantly in recent decades, yet no standard screening strategy exists. Screening aims to detect potentially precancerous lesions, anal intraepithelial neoplasia (AIN), which can be treated to prevent cancer progression. In this prospective study, we assessed the prevalence of high\u2010risk human papillomavirus (hrHPV), abnormal anal cytology, and AIN confirmed by high\u2010resolution anoscopy (HRA)\u2010guided biopsy. Women aged \u2265\u200940 undergoing routine screening colonoscopy in Cologne, Germany, were enrolled. Before colonoscopy, anal samples were collected for hrHPV testing and cytology. Participants with positive hrHPV and\/or abnormal cytology underwent HRA with biopsy and treatment if necessary. Among 483 women (November 2023\u2013March 2025), hrHPV was detected in 78 (16.1%), while cytological abnormalities were found in only 6 (1.2%). In hrHPV\u2010positive women, HRA identified low\u2010grade squamous intraepithelial lesion (LSIL) in 11 (14.1%) and high\u2010grade squamous intraepithelial lesion (HSIL) in 6 (7.7%); all lesions were treated with argon plasma coagulation. Anal symptoms (bleeding, pain, or pruritus) were associated with hrHPV positivity (adjusted PRR: 1.72;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.023). Among hrHPV\u2010positive participants, infection with multiple hrHPV types was linked to AIN (adjusted PRR: 2.90;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.017). In conclusion, hrHPV prevalence was relatively high, while cytology alone showed limited sensitivity for detecting AIN. Identification and treatment of high\u2010grade lesions, potentially precursors to anal cancer, suggest that screening could help prevent disease progression and support incorporating anal hrHPV testing into preventive strategies for women.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70727","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T04:54:17Z","timestamp":1787979257000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High\u2010Risk Human Papillomavirus Prevalence and Detection of Anal Intraepithelial Neoplasia in Women Undergoing Screening Colonoscopy: A Prospective Study"],"prefix":"10.1002","author":[{"given":"Carlo","family":"Vivaldi","sequence":"first","affiliation":[{"name":"Practice of Proctology and Endoscopy, Pan Clinic  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Schmitten","sequence":"additional","affiliation":[{"name":"Practice of Proctology and Endoscopy, Pan Clinic  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Schmid","sequence":"additional","affiliation":[{"name":"University of Bonn, University Hospital Bonn, Institute for Medical Biometry, Informatics and Epidemiology  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9693-585X","authenticated-orcid":false,"given":"Hartmut","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Practice of Proctology and Endoscopy, Pan Clinic  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.soc.2024.07.011","article-title":"Epidemiology of Anal Cancer","volume":"34","author":"English N. C.","year":"2025","journal-title":"Surgical Oncology Clinics of North America"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.soc.2024.07.003","article-title":"Pathophysiology of Anal Cancer","volume":"34","author":"Lozar T.","year":"2025","journal-title":"Surgical Oncology Clinics of North America"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1089\/vim.2023.0144","article-title":"Knowledge on Human Papillomavirus Infections, Cancer Biology, Immune Interactions, Vaccination Coverage and Common Treatments: A Comprehensive Review","volume":"37","author":"Nikmanesh N.","year":"2024","journal-title":"Viral Immunology"},{"key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s12032-023-01997-9","article-title":"Molecular Mechanisms Augmenting Resistance to Current Therapies in Clinics Among Cervical Cancer Patients","volume":"40","author":"Das S.","year":"2023","journal-title":"Medical Oncology"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.ajog.2015.03.034","article-title":"Prevalence of Anal Human Papillomavirus Infection and Anal HPV\u2010Related Disorders in Women: A Systematic Review","volume":"213","author":"Stier E. A.","year":"2015","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"2273","DOI":"10.1056\/NEJMoa2201048","article-title":"Treatment of Anal High\u2010Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer","volume":"386","author":"Palefsky J. M.","year":"2022","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/hiv.13602","article-title":"Screening and Prevention of HPV\u2010Related Anogenital Cancers in Women Living With HIV in Europe: Results From a Systematic Review","volume":"25","author":"Krankowska D.","year":"2024","journal-title":"HIV Medicine"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1002\/ijc.34850","article-title":"International Anal Neoplasia Society's Consensus Guidelines for Anal Cancer Screening","volume":"154","author":"Stier E. A.","year":"2024","journal-title":"International Journal of Cancer"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/LGT.0000000000000256","article-title":"2016 IANS International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors","volume":"20","author":"Hillman R. J.","year":"2016","journal-title":"Journal of Lower Genital Tract Disease"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1111\/his.70116","article-title":"Changes in the 6th Edition of the World Health Organization Classification of Tumours of the Digestive System","volume":"88","author":"Arends M. J.","year":"2026","journal-title":"Histopathology"},{"key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1111\/ddg.12726","article-title":"German\u2010Austrian Guidelines on Anal Dysplasia and Anal Cancer in HIV\u2010Positive Individuals: Prevention, Diagnosis, and Treatment","volume":"13","author":"Esser S.","year":"2015","journal-title":"Journal der Deutschen Dermatologischen Gesellschaft"},{"key":"e_1_2_13_13_1","unstructured":"R Core Team RFfSC \u201cR: A Language and Environment for Statistical Computing \u201d(2025)."},{"key":"e_1_2_13_14_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/LGT.0000000000000497","article-title":"Assessment of Anal Cancer Screening Tools in Detecting High\u2010Grade Anal Squamous Intraepithelial Lesions in Women","volume":"24","author":"Ramos\u2010Cartagena J. M.","year":"2020","journal-title":"Journal of Lower Genital Tract Disease"},{"key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"509","DOI":"10.14309\/ajg.0000000000001186","article-title":"Screening Women for Anal Cancers: Guidance for Health Care Professionals","volume":"116","author":"Vegunta S.","year":"2021","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_13_16_1","doi-asserted-by":"crossref","first-page":"2550","DOI":"10.1158\/1055-9965.EPI-05-0460","article-title":"Anal Human Papillomavirus Infection in Women and Its Relationship With Cervical Infection","volume":"14","author":"Hernandez B. Y.","year":"2005","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"},{"key":"e_1_2_13_17_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0037419","article-title":"Cervical, Anal and Oral HPV in an Adolescent Inner\u2010City Health Clinic Providing Free Vaccinations","volume":"7","author":"Schlecht N. 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M.","year":"1997","journal-title":"Acta Cytologica"},{"key":"e_1_2_13_21_1","first-page":"270","article-title":"Cytologic Diagnosis of Anal Intraepithelial Neoplasia Using Smears and Cytyc Thin\u2010Preps","volume":"8","author":"Sherman M. E.","year":"1995","journal-title":"Modern Pathology"},{"key":"e_1_2_13_22_1","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1002\/ijc.34199","article-title":"A Systematic Review and Meta\u2010Analysis of Cytology and HPV\u2010Related Biomarkers for Anal Cancer Screening Among Different Risk Groups","volume":"151","author":"Clarke M. A.","year":"2022","journal-title":"International Journal of Cancer"},{"key":"e_1_2_13_23_1","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/AOG.0b013e31829a2ace","article-title":"Risk Factors for Anal Intraepithelial Neoplasia in Women With Genital Dysplasia","volume":"122","author":"ElNaggar A. 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M.","year":"2021","journal-title":"Journal of Infectious Diseases"},{"key":"e_1_2_13_26_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2023.1106272","article-title":"Risk Factor Analysis of Malignant Adenomas Detected During Colonoscopy","volume":"10","author":"Hu H.","year":"2023","journal-title":"Frontiers in Medicine (Lausanne)"}],"container-title":["International Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.70727","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijc.70727","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.70727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T04:54:22Z","timestamp":1787979262000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ijc.70727"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":25,"alternative-id":["10.1002\/ijc.70727"],"URL":"https:\/\/doi.org\/10.1002\/ijc.70727","archive":["Portico"],"relation":{},"ISSN":["0020-7136","1097-0215"],"issn-type":[{"value":"0020-7136","type":"print"},{"value":"1097-0215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"2026-04-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijc.70727"}}