Preface

Zhaomin Xu, MD, MPH

Anal cancer is still a rare cancer overall, but it has been increasing in incidence, particularly in high-risk groups. The management of the associated premalignant anal dysplasia lesions has changed immensely over the last few years. This is, in large part, thanks to the Anal Cancer-HSIL Outcomes Research (ANCHOR) trial. Prior to the ANCHOR trial, recommendation for anal dysplasia screening and treatment were mostly based on expert opinion. This landmark randomized trial provided high-quality evidence that indeed, treating high-grade anal dysplastic lesions decreased the risk of anal cancer in high-risk patients.

However, there is still a significant gap in provider knowledge in the understanding of risk factors for anal dysplasia, what the treatment options are, and the evidence for treatment. Diseases of the anus have traditionally been fraught with social stigma and avoidance by providers and patients due to embarrassment and the sensitive nature of this part of the body. While colorectal surgeons in general feel very comfortable in the anorectal space, like many colorectal diseases, the care of anal dysplasia patients is a true multidisciplinary endeavor that may include providers from infectious diseases, obstetrics and gynecology, transplant, gastroenterologists, and primary care. As colorectal surgeons, our unique training puts us in a position to help lead the effort to slow the rise of anal cancer.

The purpose of this issue is to review the epidemiology and risks factors for anal dysplasia, the evolving world of pathological assessment, the options and evidence for treatment, the challenges around providing screening and treatment, and some tips for running an anal dysplasia clinic. I would like to thank the authors who contributed to this issue, and we hope this issue provides information that will help you care for these unique patients.

Publikationsverlauf

Artikel online veröffentlicht:
27. Juni 2025