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ANALYSIS OF TEMPORAL TRENDS IN ANAL CANCER INCIDENCE BY SEX, AGE, AND ETHNICITY, 2017-2021
Eli Ehrenpreis, Hoang Dang, Ashley Robinson
*, Ravjot Virdi, Yannis Lafazanos
Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL
Background: Epithelial cancer of the anus makes up 1% of all gastrointestinal cancers and more than 90% of anal cancers are caused by chronic human papillomavirus (HPV) infection. Screening for anal HPV, anal dysplasia, and cancer have been recommended for patients with HIV infection (Incidence rates, IR =22-85/100,000), bone marrow transplant recipients (IR=13/100,000), and other immuno-compromised hosts (ulcerative colitis IR=6/100,000, Crohn’s disease IR=3/100,000). A disproportionate increase in anal cancer has been seen in females, especially those over the age of 65. Therefore, elderly women represent a potential group to screen for anal cancer. We examined sex and age-specific temporal trends of anal cancer incidence, including analyzing differences between ethnicities to further characterize the epidemiology of the disease.
Methods: Using the SEER Stat program, data from the Surveillance, Epidemiology, and End Results (SEER) database was used to assess anal cancer incidence trends from 2017 to 2021,. Curve fitting of incidence data versus time using a linear growth model was performed with Prism (GraphPad, San Diego, CA).
Results: Among all ethnicities, the annual percent change (APC) in the incidence of anal cancer between 2017-2021 was 2.9% (CI 2.5-3.4%) in females and 1.6% (CI 1.1-2.2%) in males respectively. The increased cases in the female population occurred predominately in White women (see Table 1), with the largest number of cases occurring in White women over age 65, with an incidence of anal cancer in 2021 of 11.4/100,000 (CI 10.7-12.0) (see Figure 1). The 5-year APC in White women 65 or older was 4.3% (CI 3.4-6.80%), with an estimate of 16.8 years doubling time. By contrast, the incidence in Hispanic women 65 or older in 2021 was 7.5 /100,000 (CI 6.3-8.9), with a 5-year APC in this group of 1.7% (CI 0.7 to 2.8%), while in Black women 65 or older, the incidence in 2021 was 6.3/100,000, with an APC of 1.2% (CI 0.1-2.5%).
Conclusion: Anal cancer incidence rates have been increasing overall, most predominantly in women. White and Hispanic females 65 years and older have the highest incidence of anal cancer and are the groups that anal cancer is increasing most rapidly. These data point to patients who should be considered for screening for anal HPV and anal cancer.
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