Even though a number of centres in the United States, Canada, Europe and the United Kingdom have reported studies on anal cancer screening tests, anal cancer screening has not been implemented in an organized fashion in high-risk populations in any of these jurisdictions. In considering organized anal cancer screening for MSM, it would be logical to extrapolate from algorithms used in organized cervical cancer screening programs (e.g. screen using cytology and proceed to more aggressive intervention [i.e. HRA] if high grade squamous intraepithelial lesion (HSIL) is present) and apply them to anal cancer screening.