The National Health and Medical Research Council (NHMRC) has awarded $3.33 million to a Kirby Institute project to enhance screening for anal cancer; a critically under-researched disease caused by persistent infection with high-risk human papillomavirus (HPV).
Dr Mary Poynten will lead a study that will increase anal cancer screening uptake and accuracy among people living with HIV; a population that is at particular risk of anal cancer. The grant has been awarded via an NHMRC Targeted Call for Research: Anal Cancer 2025 grant opportunity, in response to the urgent need to improve awareness and provide further guidance for the prevention, diagnosis and treatment of anal cancer, which has been increasing in Australia over the past decade.
“Anal cancer is an aggressive disease, and treatments have significant side effects. Screening for and treating cancer precursor lesions, like we do with cervical cancer screening will prevent anal cancer,” says Dr Poynten. “But this requires high uptake of routine screening. There is a well-documented scarcity of knowledge about anal cancer, and a lack of awareness of the higher risk among people living with HIV and their health care providers. Our study aims to address these concerning gaps.”
For people living with HIV, an annual digital anorectal examination to detect early cancer is recommended, but uptake has been poor. Anal swab-based testing is the recommended screening test in guidelines released in Australia this year, and self-collection could help to maximise uptake. However, while current tests are highly sensitive, their specificity is poor, resulting in unnecessary follow-up procedures. But there is a novel, more accurate test available, based on DNA methylation, that may help identify those people at highest risk of progression to anal cancer. Coupled with the potential swab-based testing, there is the opportunity to improve anal cancer screening in people living with HIV.
“Our study will evaluate the effectiveness and uptake of self-collection of anal swabs as a method to increase screening uptake, as well as using this new, more specific diagnostic test to increase the accuracy of results,” says Dr Poynten. “There are around 30,000 people living with HIV in Australia, meaning that screening for all eligible people, with linkage to treatment, should be achievable. We have a real opportunity here to improve health literacy, while substantially reducing anal cancer, which will dramatically improve health and save lives.”
The study team has extensive experience in HPV-associated anal cancer research; a focus of Dr Poynten’s work for 15 years. Other Kirby Institute Chief Investigators on the study include Scientia Professor Andrew Grulich, Dr Jeff Jin, Dr Clare Dyer and Scientia Professor Anthony Kelleher.