Anal cancer in women

Holmes, Frederick F.; Borek, Deborah; Owen-Kummer, Medge; Hassanein, Ruth S.; Fishback, James L.; Behbehani, Abbas M.; Baker, Ariel B.; Holmes, Grace E.

doi:10.1016/0016-5085(88)90297-1

Cited by 83 publications

(32 citation statements)

References 24 publications

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“…These temporal associations were confirmed in a subsequent study (Lin et al, 1995). The absence of any convincing link between benign anal lesions and the risk for anal cancer in women (who constituted 78% of the case patients in this study), and the likelihood of a non-causal explanation for the statistical associations observed in men, in combination with the results from previous studies (Holmes et al, 1988; 1994; Lin et al, 1995), argue against anal inflammation as a genuine aetiological factor.…”

Section: Discussionsupporting

confidence: 81%

“…Holly et al, (EA Holly personal communication) found increased risks associated with haemorrhoids and anal fissure/fistula in a combined analysis of women and heterosexual men, but unlike for women in the present study, there was no association with anorectal abscess in either sex. Another case-control study found no significant association with fissures, fistulae or haemorrhoids and the risk for anal cancer in women (Holmes et al, 1988), while a third study did not present data on benign anal lesions (Daling et al, 1987).…”

Section: Discussionmentioning

confidence: 92%

“…One case-control study (Holly et al, 1989) provided data that were interpreted as supportive of the old belief that anal inflammation predisposes to anal cancer (Brofeldt, 1927;Buckwalter and Jurayj, 1957). However, another case-control study (Holmes et al, 1988) and two subsequent cohort studies did not accord with this view Lin et al, 1995). Based on data from a nationwide case-control study in Denmark and Sweden, we attempted to re-evaluate the association between benign anal lesions and the risk for hrHPV-positive and -negative anal cancer.…”

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confidence: 99%

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Benign anal lesions, inflammatory bowel disease and risk for high-risk human papillomavirus-positive and -negative anal carcinoma

Frisch

Glimelius²,

Brule³

et al. 1998

Br J Cancer

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Summary A central role in anal carcinogenesis of high-risk types of human papillomaviruses (hrHPV) was recently established, but the possible role of benign anal lesions has not been addressed in hrHPV-positive and -negative anal cancers. As part of a population-based case-control study in Denmark and Sweden, we interviewed 417 case patients (93 men and 324 women) diagnosed during the period 1991-94 with invasive or in situ anal cancer, 534 patients with adenocarcinoma of the rectum and 554 population controls. Anal cancer specimens (n = 388) were tested for HPV by the polymerase chain reaction. Excluding the 5 years immediately before diagnosis, men, but not women, with anal cancer reported a history of haemorrhoids [multivariate odds ratio (OR) 1.8; 95% confidence interval (Cl) 1.04-3.2] and unspecific anal irritation (OR 4.5; Cl 2.3-8.7) significantly more often than controls. Women with anal cancer did not report a history of benign anal lesions other than anal abscess to any greater extent than controls, but they had used anal suppositories more often (OR 1.5; Cl 1.1-2.0). Patients with hrHPV in anal cancer tissue (84%) and those without (16%) reported similar histories of most benign anal lesions, but anal fissure or fistula was more common among hrHPV-positive cases. Ulcerative colitis and Crohn's disease, reported by <11% of study participants, were not associated with anal cancer risk. The higher proportion of hrHPV-positive anal cancers among case patients with anal fissure or fistula suggests that such mucosal lesions may provide direct viral access to basal epithelial layers. Since risk associations with benign anal lesions in men may be confounded by unreported sexual behaviour, and since risk associations in women were generally negative, it seems unlikely that benign anal lesions act as promoters in hrHPV-associated anal carcinogenesis. Moreover, benign anal lesions appear not to be linked to an alternative, hrHPV-unassociated causal pathway to anal cancer. Ulcerative colitis and Crohn's disease were not supported as causal factors for anal cancer.Keywords: anus neoplasms; risk factors; haemorrhoids; anal fistula; anal fissure; inflammatory bowel diseases; ulcerative colitis; Crohn's disease The incidence of epidermoid anal cancer, a rare neoplasm of the anal canal and perianal skin, has increased considerably during the past decades (Goldman et al, 1989;Frisch et al, 1993;. It has been shown that anal cancer has a sexually transmitted aetiology (Daling et al, 1987;Holly et al, 1989;Frisch et al, 1997). Substantial evidence now points to the causal involvement of certain high-risk types of human papillomaviruses (hrHPV), notably HPV type 16, in the majority of anal cancers (Holm et al, 1994;Frisch et al, 1997). One case-control study (Holly et al, 1989) provided data that were interpreted as supportive of the old belief that anal inflammation predisposes to anal cancer (Brofeldt, 1927;Buckwalter and Jurayj, 1957). However, another case-control study (Holmes et al, 1988) and two subsequent cohort s...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

See 1 more Smart Citation

Benign anal lesions, inflammatory bowel disease and risk for high-risk human papillomavirus-positive and -negative anal carcinoma

Frisch

Glimelius²,

Brule³

et al. 1998

Br J Cancer

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“…Similar comments may apply to increased reporting of the lifetime num-ber of sexual partners and a history of genital warts over that reported in prior studies. [3][4][5]12 Status as a current smoker at the time of study enrollment has been a consistent risk factor in most studies of anal cancer 3,5,12,18 and in the larger population-based studies of other HPV-related SCC anogenital malignancies. 6,10,19 -24 In this study, current smoker status was related to the risk of anal cancer in both men and women.…”

Section: Discussionmentioning

confidence: 99%

“…5,10,12,19,23 Current smoking at the time of diagnosis has been associated with all HPV-related squamous cell anogenital tumors, regardless of whether HPV DNA is present in the tumor. Because it appears that it is most important if patients with cancer are current smokers at the time of diagnosis, current smoking likely has a promotional effect at late stages of disease progression.…”

Section: Discussionmentioning

confidence: 99%

Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer

Daling

Madeleine

Johnson

et al. 2004

Cancer

700

553

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BACKGROUNDThe incidence of anal cancer has increased among both men (160%) and women (78%) from 1973 to 2000 in the U.S. The authors conducted a population‐based case–control study of anal cancer to examine factors that may account for this increase.METHODSMen (n = 119 patients) and women (n = 187 patients) who were diagnosed with anal cancer between 1986 and 1998 in the Seattle area were ascertained through the local Surveillance, Epidemiology, and End Results registry. Control participants (n = 1700) were ascertained through random‐digit telephone dialing. Participants were interviewed in person and provided blood samples. Archival tumor tissue was tested for human papilloma virus (HPV) DNA, and serum samples were tested for HPV type 16 (HPV‐16).RESULTSOverall, 88% of tumors (all histologies) in the study were found to be positive for HPV. HPV‐16 was the most frequent HPV type detected (73% of all tumors), followed by HPV‐18 (6.9%), regardless of gender. However, 97.7% of tumors from men who were not exclusively heterosexual contained HPV DNA. The risk of anal cancer increased among men (odds ratio [OR], 5.3; 95% confidence interval [95% CI], 2.4–12.0) and women (OR, 11.0; 95% CI, 5.5–22.1) who had ≥ 15 sexual partners during their lifetime. Among men who were not exclusively heterosexual and women, receptive anal intercourse was related strongly to the risk of anal cancer (OR, 6.8 [95% CI, 1.4–33.8] and OR, 2.2 [95% CI, 1.4–3.3], respectively). Current smokers among men and women were at particularly high risk for anal cancer, independent of age and other risk factors (OR, 3.9 [95% CI, 1.9–8.0] and OR, 3.8 [95% CI, 2.4–6.2], respectively).CONCLUSIONSThe high proportion of tumors with detectable HPV suggests that infection with HPV is a necessary cause of anal cancer, similar to that of cervical cancer. Increases in the prevalence of exposures, such as cigarette smoking, anal intercourse, HPV infection, and the number of lifetime sexual partners, may account for the increasing incidence of anal cancer in men and women. Cancer 2004. © 2004 American Cancer Society.

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