Squamous Cell Carcinoma of the Anus Incidence, Mortality, and Survival Among the General Population and Persons Living With HIV in Puerto Rico, 2000-2016

Abstract

PURPOSE Squamous cell carcinoma of the anus (SCCA) is common among persons living with HIV (PLWH). We described SCCA incidence and survival among the general population and among PLWH in Puerto Rico (PR), along with mortality of anal cancer. METHODS PR HIV/AIDS Surveillance Program and the PR Central Cancer Registry databases were linked (2000-2016). Incidence rates (IRs) and trends (annual percent change [APC]) in SCCA and mortality rates and trends for anal cancer were estimated. Relative survival and relative excess risk (RER) of death were calculated. RESULTS From 2000 to 2016, 991 individuals in PR were diagnosed with anal cancer; 73% of cases were SCCA 9.1% of SCCA and 1.5% of non-SCCA cases were in PLWH ( P < .0001). SCCA incidence was higher among PLWH than the general population (IR = 27.7/100,000). Among PLWH, SCCA incidence (per 100,000) was the highest among men who have sex with men (IR = 60.5). From 2001-2016, SCCA incidence increased among the general population (APC: 4.90, P < .05); however, no significant change was observed among PLWH (APC = 0.19 and P = .96). The APC for anal cancer mortality in the general population was positive (3.9%) from 2000 to 2016, but not significant ( P > .05). The 5-year relative survival of SCCA was 56.9% among PLWH and 66.8% among the general population. In multivariate analysis, the RER of death for SCCA 5 years postdiagnosis was affected by stage at diagnosis (distant: RER = 7.6, 95% CI, 2.36 to 24.25) but not by PLWH status (RER = 1.4, 95% CI, 0.67 to 3.01). CONCLUSION Our findings highlight the relevance of anal cancer screening in PLWH and HPV vaccination in both PLWH and the general population in PR, which could have an impact on the disease trend in the next few decades.

Global burden of HPV‐attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis

“…Estimates of SCCA patients living with HIV are unaffected by the above methodological issue and, furthermore, can be validated against empirically observed evidence (as we compared our findings against available data from Belgium, Botswana, France, Mozambique, Rwanda, South Africa, West Africa, the United States and Puerto Rico [Table S4]). For example, our estimates of a 1% and 25% HIV prevalence in female and male SCCA in France are consistent with the 5% and 33% reported in a case series of 225 women and 137 men with SCCA, respectively, 42 and estimates of 2% and 26% HIV prevalence in female and male SCCA in Puerto Rico can be compared to 2% and 28% observed in a registry data analysis of 525 women and 197 men with SCCA, respectively 6 . This measure can be used to understand the extent to which the burden of disease falls on PLWHIV, irrespective of causality and is relevant for informing the design and evaluating the potential impact of SCCA prevention strategies and for guiding resource allocation for SCCA prevention, notably screening.…”

“…For example, our estimates of a 1% and 25% HIV prevalence in female and male SCCA in France are consistent with the 5% and 33% reported in a case series of 225 women and 137 men with SCCA, respectively, 42 and estimates of 2% and 26% HIV prevalence in female and male SCCA in Puerto Rico can be compared to 2% and 28% observed in a registry data analysis of 525 women and 197 men with SCCA, respectively. 6 This measure can be used to understand the extent to which the burden of disease falls on PLWHIV, irrespective of causality and is relevant for informing the design and evaluating the potential impact of SCCA prevention strategies and for guiding resource allocation for SCCA prevention, notably screening.…”

State Variation in Squamous Cell Carcinoma of the Anus Incidence and Mortality, and Association With HIV/AIDS and Smoking in the United States

“…The incidence and mortality rates of human papillomavirus (HPV)-associated squamous cell carcinoma of the anus (SCCA) are rising rapidly (nearly 3% per year) in the United States, particularly among adults age 50 years or older (nearly 5% per year). [1][2][3][4] Notably, SCCA incidence surpassed cervical cancer among non-Hispanic White women age $ 65 years and the incidence of these two cancers is approaching parity among women age 50-64 years. 3 The population size of US seniors (currently unvaccinated against HPV because of age ineligibility) is projected to rise (from 49 million in 2016 to 81 million in 2040), with women outnumbering men (5:4), implying that the SCCA burden (number of cases) among seniors may continue to rise.…”

Esfuerzos realizados en Puerto Rico hacia la consolidación de políticas públicas para la prevención de cánceres asociados al VPH

“…Datos más recientes indican que entre los cánceres asociados al VPH, el cáncer de orofaringe fue el 5 to cáncer más diagnosticado entre los hombres (4,0%), en comparación con el total de cánceres diagnosticados ( 2 ). Además, según registros obtenidos desde el año 2000 al 2016, mostraron un total de 991 casos de cáncer anal, lo que representa un incremento de casos de carcinoma de células escamosas del ano en un 4,90% anual ( 8 ). Estos datos demuestran la magnitud de los cánceres asociados a VPH, y la necesidad de un plan de acción basado en evidencia científica para reducir este impacto.…”