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In 1968 Wilson and Jungner published 10 criteria that a screening program should meet before it is introduced (Table 1). Several potentially suitable screening tests have since been rejected by public health authorities because they failed to meet at least one of the 10 criteria. One example is screening for prostate cancer by measuring prostate specific antigen (PSA). Not only was there no disease-specific or overall mortality benefit from PSA screening in a recent systematic review but it generated a large amount of unnecessary, costly and harmful treatment. One of the latest candidate diseases for screening in HIVinfected men who have sex with men (MSM) is anal squamous cell carcinoma, or more precisely, its likely precursor, anal intraepithelial neoplasia (AIN), also known as anal squamous intraepithelial lesions (ASIL). Although they have been revised and adapted by other workers, it is worth consideringWilson and Jungner’s original criteria before deciding to screen for ASIL to prevent anal cancer. Anal cancer is uncommon in the general population with an annual incidence of ~1.5/100 000 but it occurs much more frequently in MSM and even more commonly in MSM with HIV. In the Multicentre AIDS Cohort Study, the incidence of anal cancer was 14/100 000 person-years inMSM, 69/100 000 in HIV-positive MSM and 137/100 000 in HIV-positive MSM in the more recent antiretroviral therapy era. Another cohort study of HIV-positive MSM reported a rate of 75/100 000 person-years. The rate of 14/100 000 in MSM is comparable to rates of cervical cancer before the introduction of cervical screening. Screening for ASIL is hoped to reduce mortality from anal cancer in MSM as it has for cervical cancer. This issue of Sexual Health contains two reports on the acceptability of elements in the screening process for ASIL. They address the sixth of Wilson and Jungner’s criteria, namely that the test for the condition should be acceptable to the population. Botes, Hillman and colleagues report on 291 MSM who collected their own anal smear samples for cytological detection of ASIL. They inserted a moistened polyester swab 3–4 cm and rotated it for at least 1minute. Eighty-six percent found it very or somewhat acceptable and only one respondent regarded it as ‘not acceptable at all’. Mostly minor pain was reported by about a third of the men and bleeding by a sixth. The high acceptability reported here is consistent with that reported for self-collected anal swabs for the diagnosis of sexually transmissible infections, even if the sample-collection for cytology is more vigorous. The same group also examined the acceptability of the next recommended step in the anal cancer screening algorithm, namely high-resolution anoscopy (HRA) and biopsy. Of 105 MSM who had HRA, 70% responded to a questionnaire and 91% of these men scored HRA as either somewhat or very acceptable. Two-thirds of the men reported bleeding and just over half reported minor pain. While the total number offered HRA is not reported and the authors also comment that they did not ask respondents if they would undergo a repeat examination, these figures are very respectable for an inherently uncomfortable examination. They probably reflect well upon the amount of prior counselling given to participants and some respondents in this study did comment on the value of effective communication. Anal cancer screening also fulfils several the other criteria for screening: it is an important health problem (criterion one), and it is probably detectable at an early stage (i.e. AIN, criterion three). And criterion nine has been addressed by a modelling exercise in

Should we start screening for anal squamous intra-epithelial lesions in HIV-infected homosexual men?