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

Abstract

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.

Human papillomavirus DNA load and p16INK4aexpression predict for local control in patients with anal squamous cell carcinoma treated with chemoradiotherapy

“…1,2 Especially the role of high-risk oncogenic HPV types, most prominently HPV type 16 (HPV16), in the etiology of anal SCC is well established by a multitude of epidemiological and experimental investigations. 3,4 As a consequence, technologies for the detection of HPV DNA may constitute valuable screening tools for anal malignancies and are of important clinical relevance, especially after the development of a preventive vaccine for both men and women. 5 Depending on the method used, the prevalence of HPV DNA in anal carcinoma ranges from 75% to 100% with HPV16 (>75%) and less frequent HPV18 (<10%) detection in the majority of cases.…”

Trends in incidence of anal cancer and high‐grade anal intraepithelial neoplasia in Denmark, 1978–2008

“…4 Smoking, sexual practices and immunosuppression have been reported to increase the risk for anal cancer. 1,[5][6][7][8] The most important causative agent is, however, infection with human papillomavirus (HPV).Anal intraepithelial neoplasia (AIN) is the precursor lesion for anal cancer. Information about the occurrence of AIN is, however, still limited, the prevalence and incidence having been examined mainly in selected groups, e.g., men who have sex with men and HIV-positive patients; 7-15 few studies have included women.…”

“…4 Smoking, sexual practices and immunosuppression have been reported to increase the risk for anal cancer. 1,[5][6][7][8] The most important causative agent is, however, infection with human papillomavirus (HPV).…”

Human papillomavirus (HPV) infection: a Mozambique overview

“…In recent years the incidence of anal cancer showed a clear increase and, in particular, there was a greater increase in men than women; the incidence is particularly high in homosexual men and the risk is further increased in the presence of HIV infection [64]. Other risk factors are smoking, anal intercourse and high number of sexual partners [20]. Head and neck cancers are squamous cell carcinomas arising in the upper respiratory and digestive tract: oral cavity, oropharynx, hypopharynx and larynx, while nasopharynx and salivary glands cancers differ histologically [67].…”