Global burden of HPV‐attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis

Abstract

Squamous cell carcinoma of the anus (SCCA) is caused by HPV, and is elevated in persons living with HIV (PLWHIV). We aimed to estimate sex-and HIV-stratified SCCA burden at a country, regional and global level. Using anal cancer incidence estimates from 185 countries available through GLOBOCAN 2020, and region/country-specific proportions of SCCA vs non-SCCA from the Cancer Incidence in Five Continents (CI5) Volume XI database, we estimated country-and sex-specific SCCA incidence. Proportions of SCCA diagnosed in PLWHIV, and attributable to HIV, were calculated using estimates of HIV prevalence (UNAIDS 2019) and relative risk applied to SCCA incidence. Of 30 416 SCCA estimated globally in 2020, two-thirds occurred in women (19 792) and one-third among men (10 624). Fifty-three percent of male SCCA and 65% of female SCCA occurred in countries with a very high Human Development Index (HDI). Twenty-one percent of the global male SCCA burden occurred in PLWHIV (n = 2203), largely concentrated in North America, Europe and Africa. While, only 3% of global female SCCA burden (n = 561) occurred in PLWHIV, mainly in Africa. The global age-standardized incidence rate of HIV-negative SCCA was higher in women (0.55 cases per 100 000) than men (0.28), whereas HIV-positive SCCA was higher in men (0.07) than women (0.02). HIV prevalence reached >40% in 22 countries for male SCCA and in 10 countries for female SCCA, mostly in Africa. Understanding global SCCA burden by HIV status can inform SCCA prevention programs (through HPV vaccination, screening and HIV control) and help raise awareness to combat the disease.

State Variation in Squamous Cell Carcinoma of the Anus Incidence and Mortality, and Association With HIV/AIDS and Smoking in the United States

“…Indeed, the narrowing gap between SCCA and cervical cancer among women age $ 50 years implies that age-based screening recommendations for SCCA might also be potentially considered. 31 The current screening emphasis is on high-risk PLWHIV given their elevated risk and scarcity of screening resources; however, the contribution of HIV to the SCCA burden among older women is low (, 2%), 4,32 which implies that wide implementation of screening for PLWHIV will be unlikely to have any impact on SCCA prevention/early detection among the general population of aging women, indicating the need to identify other risk groups (eg, history of cervical precancer or highrisk cervical HPV and solid organ transplantation) that may contribute to SCCA burden greatly and thus could be potentially targeted for screening evaluation and implementation. 6,[33][34][35] Future evaluation and implementation of the approaches for early detection of anal cancer (eg, digital anorectal examination or DARE) may also be an important public health opportunity.…”

“…The incidence and mortality rates of human papillomavirus (HPV)-associated squamous cell carcinoma of the anus (SCCA) are rising rapidly (nearly 3% per year) in the United States, particularly among adults age 50 years or older (nearly 5% per year). [1][2][3][4] Notably, SCCA incidence surpassed cervical cancer among non-Hispanic White women age $ 65 years and the incidence of these two cancers is approaching parity among women age 50-64 years. 3 The population size of US seniors (currently unvaccinated against HPV because of age ineligibility) is projected to rise (from 49 million in 2016 to 81 million in 2040), with women outnumbering men (5:4), implying that the SCCA burden (number of cases) among seniors may continue to rise.…”

“…[15][16][17] Given the implementation of screening and treatment practices for PLWHIV in the most populous urban coastal regions for over 15 years (eg, New York state implemented guidelines in 2007, and HIV care providers in California have been screening for SCCA since the 1990s), [18][19][20] SCCA incidence patterns might have been affected by increased diagnostic scrutiny, particularly among men age , 50 years as HIV greatly contributes to SCCA (nearly 60%) in this age group, but 20% among men age 50-79 years. 4,21 Understanding the geographic differences in SCCA incidence and mortality patterns could contribute to etiologic hypotheses and have important implications for guiding cancer prevention interventions and clinical practices. Therefore, we evaluated patterns in SCCA incidence, burden, mortality, and associations with smoking and HIV/ AIDS prevalence (overall and among persons age , 50 and $ 50 years) in all 50 US states, the District of Columbia (DC), and Puerto Rico (PR).…”

Exploiting RIG-I-like receptor pathway for cancer immunotherapy

“…Chronic infection and inflammation are established risk factors for carcinogenesis. A substantial proportion of human cancers is attributable to chronic infection with Helicobacter pylori (H. Pylori), hepatitis B virus (HBV), hepatitis C virus (HCV), Epstein-Barr virus (EBV), Kaposi sarcoma-associated herpesvirus and human papillomavirus (HPV) [1][2][3]. Worldwide, the most prevalent microorganisms attributable to cancer incidence are H. pylori, HPV and HBV/HCV, which are most associated with gastric, cervical and liver cancer, respectively [4].…”

Comments on “Global burden of HPV‐attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis”

“…Two-thirds of the cases of anal SCC worldwide occur in women. 1 The incidence has been increasing, especially in older women who have never received a human papillomavirus (HPV) vaccination. 4 This paper by Deshmukh et al 1 reports that the proportions of anal SCC diagnosed in people living with HIV differ substantially between the two genders: Worldwide, only 3% of cases of anal SCC in women are in individuals living with HIV, while in men, 21% of cases of anal SCC are in those living with HIV.…”