Sexually Transmitted Infection as a Cause of Anal Cancer

Frisch, Mørten; Glimelius, Bengt; Aj, van den Brule; Wohlfahrt, Jan; Cj, Meijer; Jm, Walboomers; Goldman, Sven; Svensson, C.; Ho, Andrew Dean; Melbye, Mads

doi:10.1056/nejm199711063371904

Cited by 610 publications

(400 citation statements)

References 26 publications

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“…Consistent with our previous report based on earlier years of diagnosis 3 and on results from other population-based studies [12][13][14] and nonpopulation-based studies, 15-17 men who were not exclusively heterosexual were at increased risk of anal cancer. In this study, nearly half of the men with anal cancer (47.1%) were not exclusively heterosexual, compared with 6.0% of male controls (OR, 17.3; 95% CI, 8.2-36.1).…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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

Daling

Madeleine

Johnson

et al. 2004

Cancer

700

553

View full text Add to dashboard Cite

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“…13,17 We found HPV 16 in 68% of all squamous cell carcinoma with some minor differences in the different subtypes. Although most studies have reported similar observation, 1,18,19 others have noted no difference.…”

Section: Discussionmentioning

confidence: 76%

Human papillomavirus genotypes in anal intraepithelial neoplasia and anal carcinoma as detected in tissue biopsies

et al. 2010

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Human papillomavirus (HPV) infection strongly correlates with the development of anal intraepithelial neoplasias and carcinomas; however, few studies have characterized the distribution of the specific subtypes of the virus in the varying grades of dysplasia. This report characterizes the distribution of HPV 16/18 in surgical specimens with anal intraepithelial neoplasia (AIN) I-III and histological variants of anal carcinoma. A total of 111 anal surgical specimens with no dysplasia (10), AIN I-III (53), and anal carcinomas (48) were evaluated for the presence of high-risk HPV infection and subtyped by nested PCR or the Invader Assay. High-risk virus types were detected in progressively greater number of anal intraepithelial lesions from 56% in low grade to 88% in high grade. Type 16 was the prevalent subtype and was noted in 28% of low grade and 68% of high-grade lesions. Moderate dysplasias showed type 16 in 20%, a prevalence similar to that in low-grade lesions. The non-16/18 subtypes of the virus predominated and were present in 50% of the cases. Most (89%) squamous carcinomas were associated with high-risk viruses, 68% with type 16, a prevalence similar to that noted in highgrade dysplasia. Non-16/18 subtypes were encountered more frequently in squamous carcinomas from immunodeficient individuals (57% cases) as compared with immunocompetent individuals (18% cases). The similarity in the prevalence of type 16 in high-grade dysplasia and squamous carcinomas suggests that anal intraepithelial lesion III is the true precursor of squamous carcinoma and warrants aggressive management. Anal intraepithelial lesions II showed a virus distribution that was similar to low-grade dysplasia. In addition, a subset of these that were associated with type 16 or 18 showed progression, whereas those associated with non-16/18 subtypes regressed, thereby raising the possibility of conservative management for these lesions.

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“…Many published studies advocate the use of cytology in the diagnosis of anal lesions because of similarities to cervical disease and its cost-effectiveness. 9,10 Fewer studies, however, have described the cytomorphologic features and diagnostic limitations associated with this new specimen type. [13][14][15] The current study evaluated the use of anorectal cytology in a high-risk population and the cytomorphologic features associated with a variety of anorectal lesions.…”

Section: Discussionmentioning

confidence: 99%

“…5,10 Similar to cervical carcinoma, HPV infection plays a significant role in the development of anal condyloma, AIN, and anal carcinoma. 2,3,9,[17][18][19][20] It is notewor- thy that koilocytes, a common finding in cervicovaginal cytology, were less frequent and were observed in only 16 (21%) specimens. Other studies have reported the absence of koilocytosis in anorectal smears despite the presence of AIN.…”

Section: Table 4 Summary Of Cytologic Features Of Anorectal Specimensmentioning

confidence: 99%

“…It is frequently associated with squamous intraepithelial neoplasia and has a strong association with human papillomavirus (HPV). 9 Moreover, both lesions arise frequently in the squamocolumnar epithelium junction. 10 Cytology has been proposed as a potential screening tool in the evaluation of anorectal specimens for anorectal disease because of the morphologic similarities of anal and cervical SQC and intraepithelial neoplasias.…”

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confidence: 99%

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