On a quest to reduce stigmas about anal cancer
Jessica Korman, MD, wants to erase what she says is a stigma in the gastroenterology profession surrounding anal disease.
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09/01/2025
“I think gastroenterologists are uniquely positioned to help with diagnosing anal diseases, in particular anal cancer,” she said. “It is part of the digestive tract, and my mission is to help gastroenterologists remember that.”
Dr. Korman is a gastroenterologist with Capital Digestive Care in Washington D.C., where she serves as chair of its Women’s Committee and as a member of the board of managers. She’s also the medical director of the Endoscopy Center of Washington D.C.
A recipient of the 2025 AGA Distinguished Clinician Award in Private Practice, Dr. Korman has dedicated her career to educating clinicians on anal cancer screening and anal human papillomavirus. Onn the research front, she participated as an investigator in the ANAL Cancer-HSIL Outcomes Research (ANCHOR) trial, which led to international anal cancer screening guidelines.
She also co-directs the International Anal Neoplasia Society (IANS) Standard High Resolution Anoscopy course.
When she’s not serving her patients, Dr. Korman speaks in the community about anal cancer awareness and screening. In the last few years, Dr. Korman has presented grand rounds at various institutions and speaks at major medical conferences. “I just try to advocate and help gastroenterologists understand who is at risk, how to look for anal cancer, how to screen, and who to refer. If anyone invites me to speak, I generally will do it,” said Dr. Korman.
In an interview, she talked about the outcomes of the ANCHOR trial and how it may inform future research, and her work to reduce bias and stigma for LGBTQ+ patients.
You decided to become a physician after studying in Egypt and Israel and volunteering with Physicians for Human Rights. Can you talk about that journey?
Dr. Korman: I majored in Religion and Middle East studies, and I minored in Arabic. I thought I was going to become a professor of religious studies. But during my time studying abroad and volunteering for Physicians for Human Rights, I was deeply moved by how physicians connect with the core of our shared humanity. Becoming a physician allows one to meet the most fundamental of human needs—caring for another’s health—in a direct and meaningful way.
My father is a physician, a gastroenterologist, but I never considered it as a career option growing up. The year after I graduated college, I accompanied my parents to my father’s medical school reunion and I thought, ‘Why did I never think about this?’ I decided to go back to school to take the pre-med requirements. Gastroenterology seemed to combine the ability to work with my hands, do procedures, have long-term relationships with patients, and think about complex problems.
GI medicine often involves detective work. What is the most challenging case you’ve encountered?
Dr. Korman: Sometimes the patients who have very severe disorders of gut-brain interaction can be the most challenging because finding treatments for them or getting them to a place where they accept certain types of treatment can be really difficult. And of course, you have to put your detective hat on and make sure you have ruled out all the “zebras.” It can take years to build the level of trust where patients are willing to accept the diagnosis and then pursue appropriate treatment.
I always try my best, but I don’t like to give up. I will refer a patient to a colleague if they have a problem and I can’t figure out what the diagnosis is or find a treatment that works. I believe in second and third opinions. I recognize that there’s a limit to what my brain can do and that we all have blind spots. Maybe someone will look at the case with fresh eyes and think of something else.
What was the most impactful outcomes of the ANAL Cancer-HSIL Outcomes Research (ANCHOR) trial?
Dr. Korman: This was a National Institutes of Health (NIH)-sponsored, randomized controlled trial with 26 clinical sites. We studied people living with human immunodeficiency virus (HIV), as they are the most at-risk group for anal cancer.
We were looking to prove that treating high grade squamous intraepithelial lesions (HSIL) of the anal canal would lead to a significant reduction in the rates of anal cancer. No one in the medical community would accept guidelines or recommendations about what to do with anal pre-cancers until we proved that treatment worked.
We published the findings in 2022. The study concluded when we met our endpoint earlier than expected. We were able to prove that treating high grade anal dysplasia does indeed lead to a very significant reduction in progression to anal cancer. That ultimately led to guidelines. The International Anal Neoplasia Society came out with consensus guidelines on screening for anal cancer in January 2024. In August 2024, NIH, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America came out with screening guidelines for people living with HIV.
Were there any other outcomes from this research?
Dr. Korman: One of the great things about the study is that we accumulated a bank of tissue and biologic specimens. There were about 4,500 patients randomized into the trial, but about 10,000 patients screened. So, we have a massive collection of biospecimens that we can use to ask questions about the progression of HSIL to anal cancer. We would like to understand more about viral and host molecular mechanisms and hopefully find biomarkers that will identify individuals at particularly high risk of progression. It’s a more precision medicine type of approach.
Education has been a cornerstone of your career. What’s the most rewarding part of teaching the IANS standard high resolution endoscopy course?
Dr. Korman: I first took the course in 2010, and that’s when I started my journey of learning how to perform high resolution endoscopy. Last year I was asked to help co-direct the course. It is now virtual and asynchronous where everything is recorded. But it was exciting to help reorganize the course, update the lectures, and make sure that everything is current. We get to answer questions from participants from all over the world. I think there are participants from 23 countries who have taken the course, which is amazing.
Could you share your work with the LGBTQIA+ population? What specific needs/challenges does this population have with GI care?
Dr. Korman: Many people in the sexual and gender minority community have experienced discrimination in health care settings or know of someone who has. For these reasons, LGBTQIA+ people may approach health care with the expectation of a negative encounter, or they may avoid accessing care altogether. Because anal cancer disproportionately affects sexual and gender minority communities, creating a warm, inclusive environment is key to identifying who is at risk, building trust, and ensuring patients receive the care they need. When you’re talking about anal cancer, there’s a lot of stigma and shame. I think people are afraid to seek care.
Gastroenterology has traditionally been an “old boys club” but that is changing. We’re trying to work on educating people on how to recognize their own biases and move beyond them to provide care that’s affirming and where people feel that they have a safe space to talk about their concerns. Men who have sex with men, in particular living with HIV, are at the highest risk of developing anal cancer. If you don’t know that your patient is a man who has sex with men, or they don’t want to disclose that they’re living with HIV, you don’t know to screen them, and then you’re missing an opportunity to potentially prevent a cancer.
What advice would you give to aspiring medical students interested in GI?
Dr. Korman: GI is the most exciting and interesting field. We take care of so many different organs, and we’re never bored. If medical students want to get into GI, I recommend that they try to be in an office or an endoscopy center and see if it’s really for them and get some hands-on experience if possible. To be truly great at this profession, you really must see it as a calling – jump in with your whole heart and not see it as just a job. If you can do that, you’ll succeed.
How do you handle stress and maintain work-life balance?
Dr. Korman: Exercise. I try to work out at least five days a week. I can’t live without it. That keeps me going. What do I do for fun? I spend time with my family and my friends. I enjoy going to new restaurants and being outdoors, especially near a body of water. I travel, and I love watching movies. I am also guilty of binge-watching TV on a regular basis as well.
Lightning round
Coffee or tea?
Coffee, 100%
What’s your favorite book?
I can’t say I have just one, but I recently read Tomorrow and Tomorrow and Tomorrow and loved it
Beach vacation or mountain retreat?
Beach
Early bird or night owl?
Early bird
What’s your go-to comfort food?
Anything with bananas
If you could travel anywhere, where would you go?
Vietnam or African safari
What’s your favorite childhood memory?
Swim team when I was a kid
If you could instantly learn any skill, what would it be?
Playing the drums
Are you a planner or more spontaneous?
Planner, although it’s not my strong suit, if I’m being honest.
Summary content
7 Key Takeaways
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Developed a paper-based colorimetric sensor array for chemical threat detection.
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Can detect 12 chemical agents, including industrial toxins.
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Production cost is under 20 cents per chip.
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Utilizes dye-loaded silica particles on self-adhesive paper.
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Provides rapid, simultaneous identification through image analysis.
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Inspired by the mammalian olfactory system for pattern recognition.
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Future developments include a machine learning-enabled reader device.
The guidelines emphasize four-hour gastric emptying studies over two-hour testing. How do you see this affecting diagnostic workflows in practice?
Dr. Staller: Moving to a four-hour solid-meal scintigraphy will actually simplify decision-making. The two-hour reads miss a meaningful proportion of delayed emptying; standardizing on four hours reduces false negatives and the “maybe gastroparesis” purgatory that leads to repeat testing. Practically, it means closer coordination with nuclear medicine (longer slots, consistent standardized meal), updating order sets to default to a four-hour protocol, and educating front-line teams so patients arrive appropriately prepped. The payoff is fewer equivocal studies and more confident treatment plans.
Metoclopramide and erythromycin are the only agents conditionally recommended for initial therapy. How does this align with what is being currently prescribed?
Dr. Staller: This largely mirrors real-world practice. Metoclopramide remains the only FDA-approved prokinetic for gastroparesis, and short “pulsed” erythromycin courses are familiar to many of us—recognizing tachyphylaxis limits durability. Our recommendation is “conditional” because the underlying evidence is modest and patient responses are heterogeneous, but it formalizes what many clinicians already do: start with metoclopramide (lowest effective dose, limited duration, counsel on neurologic adverse effects) and reserve erythromycin for targeted use (exacerbations, bridging).
Several agents, including domperidone and prucalopride, received recommendations against first-line use. How will that influence discussions with patients who ask about these therapies?
Dr. Staller: Two points I share with patients: evidence and access/safety. For domperidone, the data quality is mixed, and US access is through an FDA IND mechanism; you’re committing patients to EKG monitoring and a non-trivial administrative lift. For prucalopride, the gastroparesis-specific evidence isn’t strong enough yet to justify first-line use. So, our stance is not “never,” it’s just “not first.” If someone fails or cannot tolerate initial therapy, we can revisit these options through shared decision-making, setting expectations about benefit, monitoring, and off-label use. The guideline language helps clinicians have a transparent, evidence-based conversation at the first visit.
The guidelines suggest reserving procedures like G-POEM and gastric electrical stimulation for refractory cases. In your practice, how do you decide when a patient is “refractory” to medical therapy?
Dr. Staller: I define “refractory” with three anchors.
1. Adequate trials of foundational care: dietary optimization and glycemic control; an antiemetic; and at least one prokinetic at appropriate dose/duration (with intolerance documented if stopped early).
2. Persistent, function-limiting symptoms: ongoing nausea/vomiting, weight loss, dehydration, ER visits/hospitalizations, or malnutrition despite the above—ideally tracked with a validated instrument (e.g., GCSI) plus nutritional metrics.
3. Objective correlation: delayed emptying on a standardized 4-hour solid-meal study that aligns with the clinical picture (and medications that slow emptying addressed).
At that point, referral to a center with procedural expertise for G-POEM or consideration of gastric electrical stimulation becomes appropriate, with multidisciplinary evaluation (GI, nutrition, psychology, and, when needed, surgery).
What role do you see dietary modification and glycemic control playing alongside pharmacologic therapy in light of these recommendations?
Dr. Staller: They’re the bedrock. A small-particle, lower-fat, calorie-dense diet—often leaning on nutrient-rich liquids—can meaningfully reduce symptom burden. Partnering with dietitians early pays dividends. For diabetes, tighter glycemic control can improve gastric emptying and symptoms; I explicitly review medications that can slow emptying (e.g., opioids; consider timing/necessity of GLP-1 receptor agonists) and encourage continuous glucose monitor-informed adjustments. Pharmacotherapy sits on top of those pillars; without them, medications will likely underperform.
The guideline notes “considerable unmet need” in gastroparesis treatment. Where do you think future therapies or research are most urgently needed?
Dr. Staller: I see three major areas.
1. Truly durable prokinetics: agents that improve emptying and symptoms over months, with better safety than legacy options (e.g., next-gen motilin/ghrelin agonists, better-studied 5-HT4 strategies).
2. Endotyping and biomarkers: we need to stop treating all gastroparesis as one disease. Clinical, physiologic, and microbiome/omic signatures that predict who benefits from which therapy (drug vs G-POEM vs GES) would transform care.
3. Patient-centered trials: larger, longer RCTs that prioritize validated symptom and quality-of-life outcomes, include nutritional endpoints, and reflect real-world medication confounders.
Our guideline intentionally highlights these gaps to hopefully catalyze better trials and smarter referral pathways.
Dr. Staller is with the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston.