The epidemiology of anal cancer

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Contents Vol 9(6)

doi:10.1071/SH12070

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The epidemiology of anal cancer

Andrew E. Grulich ^A ^E , I. Mary Poynten ^A , Dorothy A. Machalek ^A , Fengyi Jin ^A , David J. Templeton ^A ^B and Richard J. Hillman ^A ^C ^D

^A Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW 2052, Australia.
^B Royal Prince Alfred Sexual Health, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
^C Sexually Transmissible Infections Research Centre, University of Sydney, Jeffery House, Parramatta, NSW 2150, Australia.
^D St Vincent’s Hospital, Sydney, NSW 2010, Australia.
^E Corresponding author. Email: agrulich@kirby.unsw.edu.au

Sexual Health 9(6) 504-508 http://dx.doi.org/10.1071/SH12070
Submitted: 11 May 2012 Accepted: 4 June 2012 Published: 10 September 2012





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Abstract

Anal cancer comprises malignancies of the anal canal principally of two morphologic variants: squamous cell carcinoma (SCC) and adenocarcinoma. In most settings, SCC compromises more than 70% of cases. In the general population, anal cancer is uncommon, with age-standardised incidence rates mostly between 1 and 2 per 100 000 per year. However, incidence of anal SCC is increasing by 1–3% per year in developed country settings. High-risk human papillomavirus (HPV) types can be detected in 80–90% of all anal SCC cases, making it second only to cervical cancer in the closeness of its association with this virus. HPV-16 can be detected in ~90% of HPV-positive cases of anal SCC. Case–control studies have demonstrated that sexual risk factors (homosexuality in men and multiple sexual partners in women) are strongly associated with anal cancer risk. Other risk factors include immune deficiency and tobacco exposure. Anal cancer rates are highest in homosexual men, particularly in those who are HIV-positive, in whom anal cancer is among the most common of all cancers. Vaccination against HPV holds great promise for anal cancer prevention for those not already HPV-infected. For the current generation of adult high-risk populations, screening programs to allow early detection and treatment are under investigation.

Additional keywords: adenocarcinoma, homosexual, human papillomavirus, squamous cell carcinoma.

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