A meta‐analysis of anal cancer incidence by risk group: Toward a unified anal cancer risk scale

Abstract

Certain population groups are known to have higher than average anal cancer risk, namely persons living with HIV (PLHIV), men who have sex with men (MSM), women diagnosed with human papillomavirus (HPV)-related gynecological precancerous lesions or cancer, solid organ transplant recipients (SOTRs) and patients with autoimmune diseases. Our aim was to provide robust and comparable estimates of anal cancer burden across these groups. Summary incidence rates (IRs), as cases per 100 000 person-years (py), were calculated by fixed-effects meta-analysis. IRs were 85 (95% confidence interval [CI] = 82-89) for HIV-positive MSM (n = 7 studies; 2 229 234 py), 32 (95% CI = 30-35) for non-MSM male PLHIV (n = 5; 1626 448 py) and 22 (95% CI = 19-24) for female PLHIV (n = 6; 1 472 123 py), with strong variation by age (eg, from 16.8 < 30 years to 107.5 ≥ 60 years for HIV-positive MSM). IR was 19 (95% CI = 10-36) in HIV-negative MSM (n = 2; 48 135 py). Anal cancer IRs were much higher after diagnosis of vulvar (IR = 48 [95% CI = 38-61]; n = 4; 145 147 py) than cervical (9 [95% CI = 8-12]; n = 4; 779 098 py) or vaginal (IR = 10 [95% CI = 3-30]; n = 4; 32 671) cancer, with equivalent disparity after respective precancerous lesions. IR was 13 (95% CI = 12-15) in SOTRs (n = 5; 1 946 206 py), reaching 24.5 and 49.6 for males and females >10 years after transplant. Anal cancer IRs were 10 (95% CI = 5-19), 6 (95% CI = 3-11) and 3 (95% CI = 2-4) for systemic lupus erythematosus, ulcerative colitis and Crohn's disease, respectively. In conclusion, a unifying anal cancer risk scale, based upon comprehensive meta-analysis, can improve prioritization and standardization in anal cancer prevention/ research initiatives, which are in their public health infancy.

Multizonal anogenital neoplasia in women: a cohort analysis

“…Vulval squamous cell carcinoma incidence has also been increasing, especially in younger women [ 25 ]. A recent meta-analysis [ 26 ] had shown that women with vulval cancer are one of the highest risk groups for anal cancer, with an incidence rate (IR) of 48 per 100 000 person years. For women with cervical cancer and vaginal cancer the anal cancer risk was lower than for the vulva, but also with a high incidence, with an IR of 9 per 100 000 persons year for the cervix and 10 per 100 000 persons year for the vagina.…”

DNA methylation markers have universal prognostic value for anal cancer risk in HIV‐negative and HIV‐positive individuals

“…[1,2] HIV-positive (HIV+) men who have sex with men (MSM) have the highest incidence rates (85 per 100,000), followed by HIV+ men who have sex with women (32 per 100,000), and HIV+ women (22 per 100,000). [3] Besides the role of HIV, iatrogenic systemic immunosuppression e.g. for solid organ transplantation or autoimmune diseases (including Inflammatory Bowel Diseases (IBD), in particular Crohn's disease, or haematological malignancies) also increases the risk for anal cancer (up to 12 per 100,000).…”

“…HIV-negative MSM (19 per 100,000) and women with prior human papillomavirus (HPV)induced (pre-)cancer also have substantially higher incidence rates (cervical: 6-9 per 100,000 and vulvar: 42-48 per 100,000). [3] Almost all anal cancers are squamous cell carcinoma (SCC) and are, similar to cervical cancer, mainly caused by a persistent high-risk (hr)HPV infection and preceded by precursor lesions: anal intraepithelial neoplasia (AIN; graded 1-3). [4] High-grade AIN (HGAIN; AIN2-3), also called anal high-grade squamous intraepithelial lesions (HSIL), can progress to cancer.…”

Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening

“…1 In the USA, incidence of and mortality from SCCA has increased in recent decades, 2 and is now a common cancer among sexual minority men (SMM) especially HIV-positive SMM among whom incidence is 40-fold to 50-fold higher than in persons overall. [3][4][5] Since it will be decades before the benefits of HPV vaccines are fully realised, 6 screening for anal precancers and invasive disease is needed.…”