# Patients with Newly Diagnosed Cervical Cancer Should Be Screened for Anal Human Papillomavirus (HPV) and Anal Dysplasia: Results of Cost and Quality Analysis

## TL;DR

Screening women with cervical cancer for anal HPV and dysplasia reduces anal cancer cases, deaths, and healthcare costs while improving quality of life.

## Contribution

A novel Markov model demonstrates the benefits of screening cervical cancer patients for anal HPV and dysplasia.

## Key findings

- Screening reduced anal cancer incidence and deaths over 20 years compared to no screening.
- Screening saved over $1.33 billion in healthcare costs over 20 years.
- Screened patients gained 102,000 discounted QALYs compared to unscreened patients.

## Abstract

Background: HPV infections with high-risk subtypes are a risk factor for developing cervical and anal cancer. Despite HPV vaccination, the incidence of cervical and anal cancer is increasing. There has been substantial research regarding the benefits of screening men who have sex with men (MSM) and those diagnosed with HIV for anal HPV and dysplasia, but little data exists for women diagnosed with cervical cancer. Methods: We constructed a Markov model in Python 3.13 to simulate the outcomes and financial impact of screening women newly diagnosed with cervical cancer for anal HPV and dysplasia. Two matrices were used to represent the screened group and the unscreened group. In the screening group, all women received initial anal HPV screening and high-resolution anoscopy with biopsy. If biopsy results confirmed HSIL, each would receive treatment with electrocautery. The screening group would also undergo annual surveillance and follow-up treatment as necessary. In the unscreened group, women did not receive screening or treatment, and the disease process was allowed to progress naturally. Results: The initial cohort consisted of 5555 women diagnosed with cervical cancer and concurrent anal HPV. The incidence of anal cancer in the screening group was 271 vs. 375 in the unscreened group after three years, 642 vs. 1236 after ten years, and 863 vs. 2039 after twenty years. Moreover, anal cancer deaths were 1236 in the screening group vs. 9041 in the unscreened group after 10 years and 31,118 vs. 51,553 after twenty years. The screened group saved 330.1 million dollars after ten years and 1.33 billion dollars after twenty years when compared to the unscreened group. Over the life of the study, the screened group would also accrue 102,000 discounted QALYs when compared to the unscreened group. Conclusions: Our model strongly suggests that screening women diagnosed with cervical cancer for anal HPV and treating anal dysplasia leads to less anal cancer, less deaths from anal cancer, less economic impact on the healthcare system, and more QALYs for patients.