Anal cancer and marital status

Abstract

Summary Anal cancer is a rare tumour in Britain and its epidemiology has not previously been studied in this country. Several studies from the United States have shown an association between single marital status at the time of tumour registration (as a marker of male homosexuality in these populations) and the incidence of anal cancer. This study has used registry information on martial status for anal cancer The registrations for anal and colonic cancers were tabulated, by gender, marital status (single, married, divorced, separated, widowed, unknown) and 5-year age group. Colonic cancer was chosen as the control disease as there is no suggestion that a sexually transmissible agent is involved in its aetiology and it has been used previously as the control in a similar study (Daling et al., 1987). Carcinomas arising in the rectum and at the rectosigmoid junction were excluded as it could be hypothesized that the rectum may be subjected to similar sexually transmissible carcinogens as the anus, but it seems unlikely that this argument could apply to the whole of the colon.Anal tumours classified as 'anal canal' or 'anus, unspecified' (ICD 9 codes 154.2 and 154.3) were requested from the Registry computers. Since the literature on anal cancer is confused about the distinction between the anal canal and the perianal skin, tumours classified as perianal skin (ICD 9 codes 172.5 and 173.5) were excluded as these codes include a heterogeneous group of tumours whose sites could not be accurately ascertained.Marital status at tumour registration was divided into two broad groups, 'never married' (single) in contrast to 'ever married' persons (married, separated, divorced or widowed). Those individuals whose marital status was unknown were excluded from the analysis. Odds ratios (OR) were computed by the Mantel Haenszel procedure (Armitage, 1985) and their significance was estimated by a normal approximation. Approximate 95% confidence levels (CI) were computed by a normal approximation to the log odds ratio.Patients for whom the Thames Registry had no information on marital status were identified and an attempt was made to ascertain their marital status from death certificates. Also, the accuracy of marital status records in the Thames Registry was checked by comparison with death certificates for a sample of the registrations of anal and colon cancers whose marital status was apparent from the Registry information. ResultsThe results for all three Registries are shown in Figure 1. From 1975From to 1987 Although a similar trend was seen in all three Registries, the magnitude was greatest in the Thames Registry, in which the odds ratio for anal cancer was 2.8 in 'never married' men compared to 'ever married' men with a 95% confidence interval of 2.1-3.8. The risk was similar for men under the age of 50 to that in older men. For women, never married individuals had a risk of 0.5 (95% confidence interval 0.3-0.7), with no clear differences according to age (Table I).

Anal Cancer – Current Perspectives

“…These early reports have been supported by data from Dalinget al [23] and Scholefield et al [24], Daling et al [23] interviewed 148 persons with anal cancer and a further 166 control patients who had had colon cancer between 1978 and 1985. They found that in men with a history of receptive anal intercourse there was a strong correlation with occurrence of anal cancer with a relative risk of 33.1 (95% confidence interval, 4.0 to 272.1).…”

“…[24] assessed anal cancer registrations with respect to gender, marital status and 5-year age group in three regional cancer registries from England and Scotland. They found that the relative risk of develop ing anal cancer was significantly increased in single men in all three registries [24],…”

An analysis of temporal and generational trends in the incidence of anal and other HPV-related cancers in Southeast England

“…It may be that the effect of HPV infection is less in penis cancer than in the other cancers, as recently suggested (Tornesello et al, 2008). Several studies have linked sexual behaviour with cancer of the anus (Daling et al, 1987;Scholefield et al, 1990;Frisch et al, 1993Frisch et al, , 1997. In both Denmark (Melbye and Biggar, 1992) and Scotland (Brewster and Bhatti, 2006) a higher prevalence of receptive anal intercourse in women than in men has been reported, and may explain in part the higher incidence of anal cancer in women in these countries.…”

“…Increasing trends in anal cancer have been reported, possibly due to changes in sexual practices (Daling et al, 1987;Scholefield et al, 1990;Frisch et al, 1993Frisch et al, , 1997. If this were the case, a strong generational effect would be expected in the incidence trends of anogenital cancers.…”

“…Cancers of the anus, vulva and vagina occur more frequently than expected following cervical intraepithelial neoplasia III or invasive cervical cancer, suggesting a strong common aetiological factor (Evans et al, 2003). HPV infection may also play a role in a subset of penile squamous cell carcinomas (Iwasawa et al, 1993;Rubin et al, 2001; Daling et al, 2005;Heideman et al, 2007;Tornesello et al, 2008).Increasing trends in anal cancer have been reported, possibly due to changes in sexual practices (Daling et al, 1987;Scholefield et al, 1990;Frisch et al, 1993Frisch et al, , 1997. If this were the case, a strong generational effect would be expected in the incidence trends of anogenital cancers.…”