Prevalence and Risk Factors for Anal Squamous Intraepithelial Lesions in Women

Holly, Elizabeth A.; Ralston, Mary L.; Darragh, Teresa M.; Greenblatt, Ruth M.; Jay, Naomi; Palefsky, Joel M.

doi:10.1093/jnci/93.11.843

Cited by 222 publications

(159 citation statements)

References 27 publications

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“…Although comparatively smaller than the one reported for HIV-negative MSM in the EXPLORE study (20%), which was based on cytological results 19 , both prevalences are considerably higher than that described by Holly et al 17 (8%) in HIV-negative females with other risk factors for anal cancer in a study also based on cytological results.…”

contrasting

confidence: 74%

“…In HIVpositive MSM, the prevalence of ASIL is also high, and was reported to be 81% in 357 patients studied at the University of California at San Francisco 16 . In fact, anoreceptive habits increase the likelihood that male patients present ASIL compared with anoreceptive females since MSM tend to have anoreceptive sexual activity more frequently than women and also are prone to have more anal-introducer sexual partners, which makes them more likely to have anal HPV infection 17 . Furthermore, HIV infection confers MSM a relative risk 5.7 times greater to have ASIL than HIV-negative MSM 15 .…”

Section: Discussionmentioning

confidence: 99%

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Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil

et al. 2011

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Purpose:To investigate the prevalence of anal squamous intraepithelial lesions (ASIL) or anal cancer in patients attended at the Tropical Medicine Foundation of Amazonas. Methods: 344 patients consecutively attended at the institution, in 2007/2008, were distributed in the following strata according to presence/abscense of at risk conditions for anal cancer: Group 1 -HIV-positive men-who-have-sex-with-men (101); Group 2 -HIV-positive females (49); Group 3 -patients without any at risk condition for anal cancer (53); Group 4 -HIV-positive heterosexual men (38); Group 5 -HIV-negative patients, without anoreceptive sexual habits, but with other at risk conditions for anal cancer (45); Group 6 -HIV-negative men-who-have-sex-with-men (26); and Group 7 -HIVnegative anoreceptive females (32). The histopathological results of biopsies guided by high-resolution anoscopy were analyzed by frequentist and bayesian statistics in order to calculate the point-prevalence of ASIL/cancer and observe any eventual preponderance of one group over the other. Results: The point-prevalence of ASIL for all the patients studied was 93/344 (27%), the difference between HIV-positive and negative patients being statistically significant (38.3% versus 13.5%; p < 0.0001). The prevalence of ASIL for each one of the groups studied was: Group 1 = 49.5%, Group 2 = 28.6%, Group 3 = 3.8%, Group 4 = 21.1%, Group 5 = 11.1%, Group 6 = 30.8% and Group 7 = 18.8%. Standard residual analysis demonstrated that ASIL was significantly prevalent in patients of Group 1 and high-grade ASIL in patients of Group 2. The odds for ASIL of Group 1 was significantly higher in comparison to Groups 2, 3, 4, 5 and 7 (p < 0.03). The odds for ASIL of Groups 2, 4 and 6 were significantly higher in comparison to Group 3 (p < 0.03). Conclusions: In the patients studied, ASIL (low and/or high-grade) tended to be significantly more prevalent in HIV-positive patients. Nonetheless, HIV-negative anoreceptive patients also presented great probability to have anal cancer precursor lesions, mainly those of the male gender. Key words: Anal Canal. Anus Neoplasms. Epidemiology. HIV. Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in BrazilActa Cirúrgica Brasileira -Vol. 26 (1) (101); Grupo 2 -mulheres HIV-positivas (49); Grupo 3 -pacientes sem condição de risco para o câncer anal (53); Grupo 4 -homens heterossexuais HIV-positivos (38); Grupo 5 -pacientes HIV-negativos, sem hábitos sexuais anorreceptivos, mas com outras condições de risco para o câncer anal (45); Grupo 6 -homens-que-fazem-sexo-com-homens HIV-negativos (26); e Grupo 7 -mulheres HIV-negativas, com hábitos sexuais anorreceptivos (32). Os resultados histopatológicos das biópsias anais dirigidas pela colposcopia anal foram analisados por meio de estatística frequentista e bayesiana para a determinação da prevalência-ponto de ASIL/câncer e verificar eventual preponderância estatística de um grupo sobre o outro. Resultados: A prevalência-ponto de ASIL para t...

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confidence: 74%

Section: Discussionmentioning

confidence: 99%

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil

et al. 2011

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“…Information about the occurrence of AIN is, however, still limited, the prevalence and incidence having been examined mainly in selected groups, e.g., men who have sex with men and HIV-positive patients; 7-15 few studies have included women. 7,13,15 Knowledge about the incidence of AIN in the general population is necessary for understanding the natural history of AIN and anal cancer.In contrast to most other countries, Denmark has extensive registration of both anal cancer and AIN, in the Danish Cancer Registry and the Danish Registry of Pathology, respectively. Both registries are nationwide and population-based, providing a unique opportunity for studying trends over time for the entire population of Denmark.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Trends in incidence of anal cancer and high‐grade anal intraepithelial neoplasia in Denmark, 1978–2008

Nielsen

Munk

Kjær

2011

Intl Journal of Cancer

108

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The aim of the study was to determine the incidences of anal cancer and high-grade anal intraepithelial neoplasia (AIN2/3) over time in Danish women and men. Describing the burden of anal cancer and AIN may be valuable in future evaluations of the human papillomavirus (HPV) vaccine. We included all anal cancers in the Danish Cancer Register in the period 1978-2008 and all cases of AIN2/3 in the Danish Registry of Pathology. Overall and age-, period-and histology-specific incidence rates were estimated. During the 30-year period, 2,187 anal cancers were identified, two thirds of which were in women. Between 1978Between -1982Between and 2003Between -2008, the age-standardized incidence rate of anal cancer increased from 0.68 to 1.48 per 100,000 person-years in women and from 0.45 to 0.80 per 100,000 person-years in men. Although there is no systematic screening for AIN in Denmark, we nevertheless identified 608 cases of AIN2/3 during the study period. The average annual percentage change of 5% between 1998 and 2008 represents a steep increase in the incidence of AIN in both genders. Furthermore, the incidence rate of HPV-associated anal cancers increased significantly, whereas that of non-HPV-associated histological types levelled out or even declined during the 30 years of observation. In women, the increase in HPV-associated cancers was more pronounced among those under 60 years of age. Our findings indicate that vaccines against HPV might play an important role in the prevention of anal cancer and its precursor lesions.Anal cancer is relatively rare, representing less than 5% of cancers in the lower gastrointestinal tract, 1 and it is more common in women than in men. Over the past few decades, the incidence of anal cancer has been increasing throughout the world in both genders. In Denmark, a marked increase in the incidence of anal cancer was reported nearly 20 years ago, 2 with the greatest increase among women and men residing in the capital area. This led to investigations in the other Nordic countries and the United States, where similar patterns were observed; it was proposed that the increase was due to changing patterns in sexual behaviour. 3 In general, anal cancer has a fair prognosis, with 5-year survival rates greater than 70%, depending on factors such as gender, tumour stage and response to chemotherapy and radiation. 1 According to data from the SEER programme in the United States, the survival rate has improved substantially in women but not in men. 4 Smoking, sexual practices and immunosuppression have been reported to increase the risk for anal cancer. 1,[5][6][7][8] The most important causative agent is, however, infection with human papillomavirus (HPV).Anal intraepithelial neoplasia (AIN) is the precursor lesion for anal cancer. Information about the occurrence of AIN is, however, still limited, the prevalence and incidence having been examined mainly in selected groups, e.g., men who have sex with men and HIV-positive patients; 7-15 few studies have included women. 7,13,15 Knowledge a...

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“…Anal intercourse has been proposed as an important risk factor in some studies. 21,22 Nevertheless, Park et al 23 did not find a significant association between HPV infection, abnormalities at anal cytology and anal sex practices. As a caveat, this was a small study with 92 women with only nine presenting abnormal anal cytology.…”

Section: Risk Factors Implicated In Anal Intraepithelial Neoplasiamentioning

confidence: 97%

HPV infection and intraepithelial lesions from the anal region: how to diagnose?

Carvalho¹,

Ferreira²,

Bueno³

2011

Braz J Infect Dis

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In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy. Keywords: anal canal; papillomavirus infections; cell biology; carcinoma in situ.identify these pre-invasive lesions is being questioned. Such questions relate to the groups to be screened and the best way to implement it such screening. The purpose of this study was to review the literature about the use of anal cytology and anoscopy to screening and evaluation of anal intraepithelial neoplasia. ANAL CYTOLOGYAnal cytology is a noninvasive method of screening, which is performed primarily by anal secretion collection through a brush (Dacron swab) introduced into the anal canal and removed with gentle rotation movements. It is indicated to avoid anal sex and douching in the day before the procedure, since these practices can decrease cellular recovery. Special caution should be taken for not touching anal canal warts and rectum walls with the brush to avoid any fecal contamination.

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Prevalence and Risk Factors for Anal Squamous Intraepithelial Lesions in Women

Abstract: HIV-positive women had a higher risk of abnormal anal cytology than did HIV-negative women with high-risk lifestyle factors. These data provide strong support for anoscopic and histologic assessment and careful follow-up of women with abnormal anal lesions.

Cited by 222 publications

References 27 publications

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil

Trends in incidence of anal cancer and high‐grade anal intraepithelial neoplasia in Denmark, 1978–2008

HPV infection and intraepithelial lesions from the anal region: how to diagnose?

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