Anal cancer and intraepithelial neoplasia: epidemiology, screening and prevention of a sexually transmitted disease

Medford, Richard J; Salit, Irving E.

doi:10.1503/cmaj.140476

Cited by 30 publications

(29 citation statements)

References 49 publications

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“…Like other HPV-related cancers, ASCC is a preventable disease; safe sexual practices, regular screening, and, more recently, vaccination all decrease the likelihood of the infection. 5 Low health literacy and inadequate access to these preventive measures are hypothesized to mediate higher rates of HPV infection and HPV-associated cancers in patients of lower socioeconomic status (SES) and racial/ethnic minorities. 6,7 Socioeconomic disparities in ASCC outcomes have also been demonstrated, with low income and Black patients having a higher risk of death.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic disparities in timeliness of care and outcomes for anal cancer patients

et al. 2019

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Background Socioeconomic status (SES) is associated with diagnostic and treatment delays and survival in multiple cancers, but less data exist for anal squamous cell carcinoma (ASCC). This study investigated the association between SES and outcomes for patients undergoing definitive chemoradiation therapy for ASCC. Methods One hundred and eleven patients diagnosed with nonmetastatic ASCC between 2005 and 2018 were retrospectively reviewed. Socioeconomic predictor variables included primary payer, race, income, employment, and partnership status. Outcomes included the tumor‐node (TN) stage at diagnosis, the duration from diagnosis to treatment initiation, relapse‐free survival (RFS), and overall survival (OS). Age, gender, TN stage, and HIV status were analyzed as covariates in survival analysis. Results SES was not associated with the TN stage at diagnosis. SES factors associated with treatment initiation delays were Medicaid payer (P = .016) and single partnership status (P = .016). Compared to privately insured patients, Medicaid patients had lower 2‐year RFS (64.4% vs 93.8%, P = .021) and OS (82.9% vs 93.5%, P = .038). Similarly, relative to patients in the racial majority, racial minority patients had lower 2‐year RFS (53.3% vs 93.5%, P = .001) and OS (73.7% vs 92.6%, P = .008). Race was an independent predictor for both RFS (P = .027) and OS (P = .047). Conclusions These results highlight the impact of social contextual factors on health. Interventions targeted at socioeconomically vulnerable populations are needed to reduce disparities in ASCC outcomes.

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Section: Introductionmentioning

confidence: 99%

Socioeconomic disparities in timeliness of care and outcomes for anal cancer patients

et al. 2019

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“…Further, there is insufficient evidence on the progression of high-grade squamous intraepithelial lesions (hsil) to invasive cancer when compared with cervical cancer 32 . However, given the disproportionately high rates of anal cancer among hiv-positive msm, and msm in general, regular screening for hpv and anal cancer is of critical importance to reduce health disparity in this population despite current debates of screening efficacy 33 . Based on lessons learned during the early days of the AIDS epidemic, it is time to break the silence about the hiv, hpv, and hpv-related syndemics and mobilize hiv-positive msm and communities, health service providers, policy-makers, and researchers to address the current health disparities.…”

Section: Discussionmentioning

confidence: 99%

HIV-Positive MSM’s Knowledge of HPV and Anal Cancer Self-Sampling: A Scoping Review

Poon

Wong

et al. 2018

Current Oncology

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Human papillomavirus (hpv) infection is the cause of anal squamous cell cancer (ascc) in 80% of cases. Available research has also shown high prevalence of anal hpv infection among men who have sex with men (msm). However, hpv vaccination is low among msm in Canada. In light of this information, we conducted a scoping review with the aim of exploring (1) the knowledge of hpv and anal cancer among hiv-positive msm and (2) the acceptability of hpv and anal cancer self-sampling in this population. In conducting the review, we searched five electronic databases for peer-reviewed articles and abstracts published in English, between 2007 and 2017. A total of 803 articles were retrieved; after accounting for duplicates (40) and unmet criteria (754), a total of 794 articles were excluded. A final total of nine articles were used in this review. Results of this review show that hiv-positive msm have limited knowledge regarding the risks of anal cancer associated with hiv and hpv coinfection. Furthermore, there is limited research on hpv and anal cancer self-sampling in this population. However, the review of available studies suggested that hiv-positive msm were open to anal cancer self-sampling. It also identified potential barriers to self-sampling. In conclusion, we provide suggestions and future directions for policy-makers and educators to develop inclusive and accessible strategies to reach hiv-positive msm regarding anal cancer education and self-screening.

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“…Squamous cell carcinoma of the anal canal (SCCA) is a relatively rare disease in the general population, but its incidence has been increasing in high‐risk population groups . The main risk factors for SCCA are human papillomavirus (HPV) infection, men having sex with men, HIV infection, and smoking . In women, particularly women living with HIV (WLWH), an additional risk factor is a history of cervicovaginal (lower genital tract) dysplasia .…”

Section: Introductionmentioning

confidence: 99%

Importance of anal cytology and screening for anal dysplasia in individuals living with HIV with an emphasis on women

Cimic

Wilkin

Heymann

et al. 2019

Cancer Cytopathology

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BACKGROUND:The incidence of squamous cell carcinoma of the anal canal has been increasing in high-risk populations.To the authors' knowledge, there is no international consensus regarding screening for squamous cell carcinoma of the anal canal, but screening is commonly comprised of a Papanicolaou (Pap) test in combination with digital anorectal examination followed by high-resolution anoscopy if necessary. The current study focused on individuals living with HIV and particularly on women living with HIV. METHODS: In this 5-year retrospective study, the authors identified 5982 Pap tests, 1848 of which had follow-up biopsy within 6 months. The rate of atypical squamous cells of undetermined significance was 42%, and approximately 38.1% of cases with this interpretation were diagnosed as high-grade squamous intraepithelial lesions on follow-up biopsy. In addition, 82 women with anal cytology had long-term follow-up (>10 years) available. RESULTS: The authors investigated a relationship between cervicovaginal human papillomavirus (HPV) results, cervical pathology, CD4 T-cell count, and CD4/8 ratio with the anal cytology interpretation. A statistical correlation was noted between the CD4 count and the CD4/8 ratio and the presence of anal dysplasia. Nearly one-half of the women without cervicovaginal HPV positivity presented with anal dysplasia. CONCLUSIONS: The results of the current study demonstrated that, among women living with HIV, screening for anal dysplasia should not be eschewed, regardless of lower genital tract pathology and/or HPV status. To the authors' knowledge, the current study is the largest reported retrospective anal cytology cohort in individuals living with HIV.

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Anal cancer and intraepithelial neoplasia: epidemiology, screening and prevention of a sexually transmitted disease

Cited by 30 publications

References 49 publications

Socioeconomic disparities in timeliness of care and outcomes for anal cancer patients

Socioeconomic disparities in timeliness of care and outcomes for anal cancer patients

HIV-Positive MSM’s Knowledge of HPV and Anal Cancer Self-Sampling: A Scoping Review

Importance of anal cytology and screening for anal dysplasia in individuals living with HIV with an emphasis on women

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