Anal High-risk Human Papillomavirus Infection, Squamous Intraepithelial Lesions, and Anal Cancer in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Abstract

Background Ulcerative colitis (UC) and Crohn’s disease (CD) can be associated with severe comorbidities, namely opportunistic infections and malignancies. We present the first systematic review and meta-analysis evaluating the burden of anal human papillomavirus disease in patients with UC and CD. Methods PubMed, Web of Science and Scopus were searched until November 2022. Meta-analyses were performed using random effects models. The protocol was recorded at PROSPERO register with the number CRD42022356728. Results Six studies including 78 711 patients with UC with a total follow-up of 518 969 person-years described the anal cancer incidence rate. For anal cancer incidence rate in CD, six studies were selected including 56 845 patients with a total follow-up of 671 899 person-years. The incidence of anal cancer was 10.2 (95%CI 4.3−23.7) per 100 000 person-years in UC and 7.7 (3.5−17.1) per 100 000 person-years in CD. A subgroup analysis of anal cancer in perianal CD including 7 105 patients was calculated with incidence of 19.6 (12.2−31.6) per 100 000 person-years (three studies included). Few studies described prevalence of anal cytological abnormalities (four studies including 349 patients), and high-risk human papillomavirus (three studies including 210 patients), with high heterogeneity. Prevalence of cytological abnormalities or high-risk human papillomavirus was not associated with pharmacological immunosuppression in the studies included. Conclusion The incidence of anal cancer is higher in UC than in CD, with the exception of perianal CD. There is limited and heterogenous data on anal high-risk human papillomavirus infection and squamous intraepithelial lesions prevalence in this population.

Monitoring Patients With Inflammatory Bowel Disease at High Risk of Anal Cancer

“…Various small studies and case reports over the past 40 years have also associated IBD with risk of anal cancer (2–4). More recent (5) meta-analyses have confirmed a trend that we are seeing within our own practices—that patients with IBD experience anal cancer at a significantly higher rate than the general population (6). Despite this, there is a paucity of literature outlining anal cancer screening and treatment guidelines for patients with IBD.…”

“…One 2017 study of 46 patients with IBD revealed prevalence rates of 43.5% and 8.7% of low-grade squamous intraepithelial lesions and HSIL, respectively (16). The largest and most recent meta-analysis by Albuquerque et al (6) reported an annual anal cancer incidence of 10.2 per 100,000 person-years in UC, 7.7 per 100,000 person-years in CD overall, and a shocking 19.6 per 100,000 person-years in a subgroup of patients with perianal CD, which includes those who have inflammation, fissures, fistulae, abscesses, or stenosis near the anus. In a 2018 cohort study of 19,486 patients with IBD, Beaugerie et al (17) reported a high rate of anal cancer in patients with perianal Crohn's of 64 per 100,000 person years.…”