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The anal Pap test is a method for screening for anal cancer and precancerous lesions. It essentially uses the same techniques as those of cervical screening.
Note that this technique is still being evaluated, and that there is currently no Medicare rebate.
It is very important that you appropriately counsel your patients regarding the potential risks and benefits of the procedure before undertaking an anal Pap smear.
Cytological examination of anal specimens is quite specialised, and you should first discuss this with your local laboratory before sending any material.
It is currently unknown whether anal douching prior to taking the test affects the quality of the specimen.
Cells from the lining of the anal canal are collected using a Dacron swab, pre-moistened with tap water. It is inserted 5cm, directly into the anal canal, without the use of a proctoscope. In a spiral manner, and with firm pressure, it is rotated and gradually withdrawn over a 1 minute period.
The swab is then eluted into a fixative (such as ThinPrepTM) and sent to a laboratory.
If anal cancer is a significant concern, then a digital ano rectal examination should be performed after the Pap smear has been taken.
Consider screening for other anal STIs, if the history suggests that the person may be at risk.
The procedure itself is usually well tolerated, although some people have some mild discomfort during and immediately after the swab has been taken. Rarely, minor bleeding is noted for a short while afterwards.
The result will be one of:
It is very important that you appropriately counsel your patients regarding the possible meaning of the results.
Caution is required in the interpreting of anal Pap results. The sensitivity and specificity are typically around 60%. It is important to note that this test does not reliably detect cancer - if you have any concerns, then please refer urgently for a specialist opinion.
If you suspect that your patient is at very high risk of anal cancer, they may be referred to the Dysplasia and Anal Cancer Services (DACS), IBAC, Level 4 Xavier Building, at St. Vincent's Hospital, Sydney. Your patient will need a referral letter. However, if the matter is urgent, please ring (02) 8382 3707.