A new studyrevealed older people and young Black men are most affected by anal cancer. The study, published by the Journal of the National Cancer Institute, found that squamous cell carcinoma of the anus (SCCA) incidence is rising in the United States.
The study explains that SCCA incidence increased 2.7% per year from 2001 to 2015, with “pronounced increases in age groups 50 years and older.” The cases of anal cancer increased most in instances of these older adults, as well as young Black men born around 1986. To better understand the findings of the study, we spoke to AdventHealth fellowship-trained colon and rectal surgeon Justin Kelly, MD, FRCS.
“Perhaps one of the reasons for the disease increase is the greater prevalence of anal dysplasia in HIV,” Dr. Kelly says. “That goes in tandem with an increase in human papillomavirus (HPV) amongst that population allied to improved awareness and diagnostics in both patients and treating physicians and the emergence of the Prep (pre-exposure prophylaxis) agents,” he added.
Connection With HPV
“Greater than 90% of anal squamous cell cancers are associated with HPV,” says Dr. Kelly, adding, “Furthermore, HPV, particularly subtypes 16 and 18, are risk factors for the progression of low-grade to high-grade squamous intraepithelial lesion which is the precursor state of cancer — especially in people who have HIV or males who have unprotected intercourse with males.”
HPV is the most common type of sexually transmitted infection, and while it is usually harmless, it can lead to cancer in some cases. The increase in anal cancer cases for certain age groups could be linked to the introduction of the first HPV vaccine in 2006. Anyone over age 26 at that time would probably not have been offered the vaccine to prevent HPV.
Risk Factors and Prevention
People who are at risk of developing a benign, pre-cancerous form of HPV include anyone who has a compromised immune system — such as a person with HIV, or undergoing chemotherapy or had a solid organ transplant (like lung, heart or kidney). Others who have an increased risk of HPV include men who have unprotected intercourse with men and women who have had cervical dysplasia. “30% of women who have cervical dysplasia will also have anal dysplasia, so it’s also imperative they get screened for this as well,” says Dr. Kelly.
Monitoring any existing cells is very important in preventing those cells from becoming cancerous over time, notes Dr. Kelly: “When you talk about anal dysplasia — the benign, pre-cancerous lesion — we know that it is incredibly important for those patients should enter a surveillance program that includes either high-resolution anoscopy every 612 months or at least regular office-based check-ups.”
In a 2018 four-year study of 2,000 patients in Boston, Mass., it was discovered that about 8% of patients with benign anal intraepithelial neoplasia will develop full-blown SCCA. “Of that 8% of people who are diagnosed with invasive cancer, 30% were staged as a T2 lesion or higher, so it’s not insignificant,” says Dr. Kelly.
If a biopsy confirms SCCA, 80% of patients will be treated completely and cured with chemoradiotherapy, as per the Nigro protocol. The remaining patients who get persistent or recurrent disease can now enter cutting edge clinical trials offering novel immunotherapy agents with AdventHealth.
AdventHealth Medical Group Colorectal Surgery has recently established a dedicated Anal Dysplasia Clinic, the first of its kind in Central Florida. Here, there is an open-door policy where all patients are welcome and are seen by a specialist. Next-day appointments are offered as standard. Most importantly, all diagnostic and treatment options, such as Pap smears and high-resolution anoscopy, can be completed easily in the office so there is no need for formal general anesthesia. “The clinic is a one-stop shop for patients who are at-risk or have documented precancerous or cancerous cells,” says Dr. Kelly.
If you are in the at-risk population, talk to your doctor to learn more about preventing SSCA.
Keeping You Safe During Your Visit
If you’ve put off your visit with a care provider, rest assured knowing you can come in and be taken care of. We have been employing these added safety measures and protocols to ensure you and your loved ones feel confident, protected and safe in our facilities:
- Contactless registration and check in
- Frequent cleaning and disinfecting
- Separate care areas for patients who are sick
- Social distancing in waiting areas
- Temperature checks upon arrival
- Universal face mask policy
- Updated visitor policy allowing only one visitor per patient
Click here to learn more about Dr. Kelly and make an appointment at Central Florida’s only dedicated Anal Dysplasia Clinic.