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Digital Anal Rectal Examination Usage Among Individuals at Increased Risk for Anal Cancer. J Low Genit Tract Dis 2023 Jul 01;27(3):242-247



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Pubmed Central ID




Scopus ID

2-s2.0-85164066580 (requires institutional sign-in at Scopus site)   1 Citation


OBJECTIVE: Multiple organizations recommend an annual digital anal rectal examination (DARE) for people at highest risk for anal cancer. The authors assessed DARE usage among sexual minority men and transgender women.

METHODS: Community-recruited and asymptomatic individuals from a mid-sized US city were enrolled into the Prevent Anal Cancer Self-Swab Study, a longitudinal clinical trial of anal cancer screening. Self-reported data from the baseline survey were used to assess usage of DARE in the last year and during the lifetime. Adjusted odds ratios (aORs) and CIs for factors associated with each outcome were determined using multivariable logistic regression.

RESULTS: Among 241 participants, median age was 46 years (interquartile range, 33-57 years), 27.0% were living with HIV, and 24.5% reported a previous diagnosis of anal warts. A total of 13.7% (95% CI = 9.4%-18.0%) of individuals reported a DARE in the previous year, whereas 53.9% (95% CI = 47.7%-60.2%) reported a DARE during the lifetime. The following were associated with a DARE in the previous year: increasing age (aOR = 1.04; 95% CI = 1.01-1.08 for each additional year), any previous anal cytology (aOR = 2.62; 95% CI = 1.19-5.80, compared with no previous test or no knowledge of a test), and preferred receptive position during anal sex (aOR = 4.93; 95% CI = 1.17-20.86 compared with insertive).

CONCLUSIONS: Despite guidelines recommending an annual DARE, it was uncommonly reported. There is an urgent need to understand barriers to conducting DARE among individuals most vulnerable to anal cancer and their health care providers.

Author List

Nyitray AG, Ridolfi TJ, Nitkowski J, McAuliffe TL, Deshmukh AA, Giuliano AR, Chiao EY, Prevent Anal Cancer Self-Swab Study Team


Timothy L. McAuliffe PhD Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Alan Nyitray PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Timothy J. Ridolfi MD, MS, FACS Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anus Neoplasms
HIV Infections
Homosexuality, Male
Middle Aged
Sexual Behavior
Sexual and Gender Minorities