No, the US Preventive Services Task Force (USPSTF) does not currently recommend routine anal Pap screening for any population, including gay men.
The USPSTF has not issued any recommendation for or against anal cancer screening in any risk group, meaning there is insufficient evidence to support routine screening even in high-risk populations like gay men.
Current Evidence Landscape
The provided evidence does not include any USPSTF guidelines on anal cancer screening—because none exist. However, other professional organizations have weighed in:
What the Guidelines Say
The 2021 ESMO guidelines explicitly state that anal cytology screening "cannot be routinely advocated at present" for high-risk populations, including gay, bisexual, and other men who have sex with men (GBMSM), despite these groups having elevated risk 1. The key reasons cited include:
- No randomized controlled trials have demonstrated that screening prevents anal cancer or reduces mortality
- Uncertain natural history of anal HPV and high-grade squamous intraepithelial lesions (HSIL)
- Variable performance of anal cytology depending on operator skill
- Quality of life concerns, as abnormal screening results may cause psychological distress 1
Emerging Consensus from Specialty Societies
While the USPSTF remains silent, the 2024 International Anal Neoplasia Society (IANS) consensus guidelines recommend screening initiation at age 45 for MSM without HIV 2. This represents expert consensus rather than USPSTF-level evidence, and notably recommends starting at age 45, not 35.
For your 35-year-old patient specifically:
- Even by IANS guidelines, he would not yet meet the age threshold for screening (age 45) unless he has HIV, in which case screening would start at age 35 2
- The 2014 review confirms that "no national health care organizations currently recommend the use of anal Pap smears as a routine screening test, even among high-risk groups" 3
Clinical Reality vs. Evidence
Despite lack of formal recommendations, screening uptake remains very low even in high-risk populations. Recent data from 2026 shows only 8.3% of eligible individuals received anal cytology screening in major U.S. metropolitan areas 4, and 14.2% at an LGBTQ+ community clinic 5.
Key Caveats
- HIV status changes everything: If your patient is HIV-positive, both IANS and expert opinion support screening starting at age 35 2
- Symptoms warrant evaluation: Any anal symptoms, visible lesions, or palpable abnormalities require digital anorectal examination and biopsy regardless of screening guidelines 1
- HPV vaccination is prevention: The focus should be on HPV vaccination for primary prevention, which is expected to reduce anal cancer incidence 1
For an asymptomatic, HIV-negative 35-year-old gay man, routine anal Pap screening is not recommended by any major U.S. guideline organization, including the USPSTF.