The Role of Demographics, Social Deprivation and Ethnicity on Anal Squamous Cell Carcinoma Incidence in England

Abstract

Anal Squamous Cell Carcinoma (ASCC) is an HPV-related malignancy with increasing incidence in high-income economies. Although ethnicity and social deprivation are known to be risk factors in other malignancies, little is known about socioeconomic status and risk of ASCC. This is a cross-sectional study following the STROBE Statement. Demographic data from the English Clinical Outcomes and Services Dataset (COSD) were extracted for all patients diagnosed with ASCC in England between 2013 and 2018. Outcomes included ethnicity, social deprivation, staging and treatment. This study included 5457 patients. Incidence increased by 23.4% in 5 years, with female incidence increasing more rapidly than male incidence (28.6% vs. 13.5%). Men were more likely to present with early staging (p < 0.001) and have surgery as their only treatment (p < 0.001). The rate of incidence of Stage 1 tumours in men was 106.9%; however, women had the greatest increase in metastatic tumours (76.1%). Black Caribbean and Black African patients were more likely to present at an earlier age with later staging (p < 0.001) and social deprivation was associated with younger age (p < 0.001). ASCC incidence is rapidly increasing in patterns consistent with two separate populations: one male with early staging, the other female and related to social deprivation and ethnicity factors.

Demographics and incidence of anal squamous cell carcinoma in people living in high HIV prevalence geographical areas

“…This is interesting, as it not only demonstrates the male PLWH effect that we were investigating, it reiterates the findings of the previous analysis3 that, as areas of high HIV prevalence, are also areas with higher ethnic diversity and social deprivation than average HIV prevalence areas, both social deprivation and ethnicity factors that can result is a poorer prognosis of patients with ASCC.…”

“…We undertook an analysis of the ASCC patient demographics and outcomes in England between 2013 and 2018 in particular to examine whether the rapidly increasing rate of incidence of early disease in men described in a previous analysis of this dataset3 originated from areas of high HIV prevalence.…”

“…The primary end outcome of this study was to identify if there were any differences in ASCC incidence in men and women between CCGs with high HIV prevalence and CCGs with average HIV prevalence. In particular to assess whether the rapid increase in incidence in men with early staging previously reported3 is associated with high HIV prevalence areas. Secondary end outcomes included whether there was any difference in age, gender, ethnicity, staging, SES and treatment received between high HIV prevalence and average prevalence CCGs.…”

“…The incidence rate of ASCC is rapidly increasing in economically developed countries, where the percentage incidence change has increased annually between 2.5%–6.3% per year in men and 2.7%–11.4% per year in women between 1989 and 2007 2. In England, the incidence rate in 2017 was 1.9 cases per 100 000 people; however, this was associated with a rapid increase in incidence over 5 years (23.4%) 3…”

Anal Cancer Screening: Unveiling its Importance

“…AC incidence is the highest in women compared to men and is rising more rapidly in women compared to men (28.6 versus 13.5%, respectively), considering data from England between 2013 and 2017 [25]. Moreover, females are more likely to present late with advanced cancers, taking into consideration data from the Surveillance, Epidemiology and End Results Program (SEER) demonstrated that women are more likely to present with advanced staging, receive radiotherapy, and die of AC [35].…”