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Anal cancer rates and mortality have risen dramatically among Americans

From left to right: Ryan Suk, MS; Ashish Deshmukh, PhD, MPH; and Kalyani Sonawane, PhD.
UTHealth School of Public Health researchers from left to right: Ryan Suk, MS; Ashish Deshmukh, PhD, MPH; and Kalyani Sonawane, PhD. (Photo by Maricruz Kwon/UTHealth)

Rates of new anal cancer diagnoses and deaths related to human papillomavirus (HPV), the most common sexually transmitted infection, have increased dramatically over the last 15 years, according to researchers at The University of Texas Health Science Center at Houston (UTHealth). The results of their study were published in the November issue of the Journal of the National Cancer Institute.

The study was the first to compare and categorize contemporary national trends in incidence of squamous cell carcinoma of the anus, a type of anal cancer caused by HPV, by stage at diagnosis, year of birth, and mortality. It found that anal cancer diagnoses, particularly advanced stage disease, and anal cancer mortality rates had more than doubled for people in their 50s and 60s. The study also revealed that new diagnoses among black men born after the mid-1980s increased five-fold compared to those born in the mid-1940s.

“Given the historical perception that anal cancer is rare, it is often neglected. Our findings of the dramatic rise in incidence among black millennials and white women, rising rates of distant-stage disease, and increases in anal cancer mortality rates are very concerning,” said Ashish A. Deshmukh, PhD, MPH, the study’s lead author and an assistant professor at UTHealth School of Public Health.

Anal cancer occurs where the gastrointestinal tract ends and is different from colon or rectal cancer due to the cell type and location where cancer develops. Cancer of the anus is most similar to cervical cancer, a cancer of the tissue that lines a woman’s cervix. A distant-stage diagnosis means cancer has spread to other parts of the body, decreasing survival rates. Nearly 90% of anal cancers are caused by HPV.

The researchers analyzed data from all cancer registries in the U.S. and identified 68,809 cases of anal cancer and 12,111 deaths from 2001 to 2016. They found that anal cancer rates and mortality increased by nearly 3% per year – suggesting it may be one of the most rapidly rising causes of cancer incidence and mortality.

The virus is preventable through vaccination, but 50% of Americans are not vaccinated – setting up a potential wave of future infections leading to cancer. The Centers for Disease Control and Prevention recommends a two-dose regimen for children starting the series before age 15 or a three-dose regimen if the series is started at age 16 through 26.

“The vaccine can also be considered for individuals ages 27 to 45 based on shared decision-making, so it is important that adults speak with their health care providers about getting the vaccine,” Deshmukh said.

“Screening for anal cancer is not currently performed, except in certain high-risk groups, and the results of this study suggest that evaluation of broader screening efforts should be considered,” said senior author Keith Sigel, MD, PhD, MPH, associate professor of medicine at Icahn School of Medicine at Mount Sinai. 

Anal cancer is often neglected and stigmatized, despite high-profile deaths such as actress Farrah Fawcett of “Charlie’s Angels” fame and the revelation of an anal cancer diagnosis by former “Desperate Housewives” star Marcia Cross, whose husband also developed throat cancer linked to HPV.

“It is concerning that over 75% of U.S. adults do not know that HPV causes this preventable cancer. Educational campaigns are needed to increase awareness about the rising rates of anal cancer and importance of immunization,” Deshmukh said.

Other UTHealth authors of the study included Ryan Suk, MS, and Kalyani Sonawane, PhD. Meredith S. Shiels, PhD, from the National Cancer Institute; Alan G. Nyitray, PhD, of the Medical College of Wisconsin; Yuxin Liu, MD, PhD, and Michael M. Gaisa, MD, PhD, of the Icahn School of Medicine at Mount Sinai; and Joel M. Palefsky, MD, from University of California, San Francisco, were also co-authors.

Research was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) (R01CA232888 and UM1CA121947), and the NCI’s intramural research program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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