NOTE

🌱 created from: anal cancer

epidemiology_of_anal_cancer

• Estimated 9,090 new cases & 1,430 deaths in 2021 (American Cancer Society)
• Increasing incidence (1.9-fold for men, 1.5 for women) from 1970s to 2000s
• association with
  • HPV,
  • receptive anal intercourse,
  • MSM,
  • STD,
  • cervical/vulvovaginal CA,
  • immunosuppression (transplant or HIV),
  • hematologic malignancy,
  • AI d/os,
  • smoking
• HPV (dsDNA nonenveloped virus) is the #1 causative agent;
  • HPV DNA detected in 84% of specimens (commonly HPV-16, HPV-18)
• HPV prevalence is ↑ in MSM pop
  • (detectable in 1/3 of HIV+ men & 1/8 of HIV− men)
• HAART ↑ HIV-assoc survival
  • but does not impact progression of anal CA.
  • This contributes to recent ↑ in anal CA incidence from 19 → 78/100k among HIV+ pts
• HPV vaccination likely to be effective (NEJM 2011;365:1576)
• High-grade squamous intraepithelial neoplasia (HSIL) can be a precursor lesion
• Evidence for screening & tx of HSIL (vs. observation) is limited