Why a special issue on anal cancer and what is in it?

Abstract

Abstract. This editorial describes the contents of this special issue of Sexual Health devoted to anal cancer. The aim of the issue is to provide readers with information to assist them in making decisions about what to do about detecting anal cancer early in men who have sex with men with HIV. Should they be advocating screening? It discusses the epidemiology of HPV infection, anal intraepithelial neoplasia, and anal cancer in MSM, heterosexual men and women; anal cancer screening and treatment of anal cancer. And most importantly, what should be done about vaccinating boys with the HPV vaccine.Received 10 July 2012, accepted 3 September 2012, published online 27 November 2012Welcome to this special issue on anal cancer, which we commissioned because of the considerable uncertainty -and at times frank disagreement -about how to deal with the important public health issue of anal cancer in men who have sex with men (MSM). Some practitioners are advocating population-based screening of MSM, regardless of their HIV status. Others are not convinced that screening is appropriate but most of us remain quite unsure about what to do. Yet while we deliberate, rates of anal cancer appear to be increasing among MSM with HIV to levels similar to those of bowel cancer in the general population. We hope this special issue will assist you in deciding where you stand about this important public health issue.The magnitude of the problem is, perhaps, one of the most important points. Grulich et al. describe the epidemiology of anal cancer, highlighting its relatively low rate in the general population but considerably higher rate in MSM, particularly in those with HIV where it approaches~100 per 100 000. 1,2 Despite only a relatively small proportion of the population being MSM, the high rate among MSM is clearly apparent at a population level. Poynten et al. describe a much higher incidence of anal cancer in postcodes where gay men more commonly live compared with postcodes where they do not commonly live. 3 And this problem will not go away, with rates of anal cancer rising in both men and women in all countries where time trends have been described. 4 Pandey describes the anal anatomy, an understanding of which is important for interpreting examination and investigation findings, the pathogenesis of conditions such as internal haemorrhoids and the spread of metastatic anal cancer. 5 Heywood and Smith review published data on anal sexual practices and highlight the paucity of data that are available at a population level. 6 They make the important point that in many populations, perhaps twice as many heterosexuals engage in anal intercourse as homosexual men, particularly in some countries in Latin America, where heterosexual anal sex is more common. 6 They highlight the paucity of data on the frequency of anal sex and other activities such as digital stimulation, which could potentially transmit the human papillomavirus (HPV). 6 Machaleck et al. take on the task of describing the epidemiology of anal HPV infection in MSM. 7 T...

Clinical characteristics and prognosis of anal squamous cell carcinoma: a retrospective audit of 144 patients from 11 cancer hospitals in southern China

“…Anal cancer is a malignancy accounting for 1–2% of digestive tract tumours and 2–4% of colorectal and anal tumours [ 1 – 3 ]. In the general population, anal cancer is rare with an overall incidence rate between 1 and 2/100,000 person-years [ 4 ]. It arises from the squamous epithelium of the anal canal and/or perianal skin.…”