Jill Fuller, a nurse practitioner with PA Thrive Partnership at Pennsylvania Western University, is at the forefront of expanding anal cancer screening in northwestern Pennsylvania.   

The push for expanded screening follows the release of the first-ever national and international guidelines from the International Anal Neoplasia Society (IANS) and the National Institutes of Health (NIH). These guidelines provide clear recommendations on who should be screened and how to manage results.    

Recognizing the lack of awareness and access to testing, Fuller and her team have been performing anal Papanicolaou (Pap) smears on their high-risk patients, leading to early detection and treatment.   

“These guidelines are a game-changer,” Fuller said. “We now have the research and framework to integrate anal cancer screening into routine care, just as we do with cervical cancer.”    

Fuller is also working to raise awareness among healthcare providers, many of whom are unfamiliar with the new guidelines. She hopes her research and advocacy -- published in the March 2025 issue of The Journal for Nurse Practitioners -- will encourage more clinicians to adopt anal Pap screenings, particularly for high-risk individuals.   

Her article, Incorporating Anal Papanicolaou Tests Into Clinical Practice: New Consensus Guidelines, provides the science behind this screening tool.  

Anal cancer is primarily caused by the human papillomavirus (HPV), a common virus that can lead to precancerous and cancerous cell changes. Those at highest risk include people living with HIV, engaging in anal intercourse, individuals with a history of cervical or vaginal cancer and those with immunocompromised health conditions, such as autoimmune diseases.   

The screening process involves a simple and quick anal Pap test, similar to a cervical Pap smear. This screening can be adopted by family practice and gynecology providers in the office setting.  If abnormalities are found, a referral to a local colon/rectal specialist for further examination through high-resolution anoscopy (HRA) can help identify and treat precancerous lesions before they develop into cancer.   

As a nurse practitioner, Fuller believes her role is vital in expanding access to essential screenings and preventive care. “Nurse practitioners are in a unique position to bridge gaps in healthcare,” she said. “We take the time to listen, educate, and advocate for patients who may not otherwise have access to critical services. This is about meeting people where they are and ensuring they get the care they need.”