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. Author manuscript; available in PMC: 2016 Sep 1.
Published in final edited form as: Am J Obstet Gynecol. 2015 Mar 19;213(3):278–309. doi: 10.1016/j.ajog.2015.03.034

Table 5. Incidence of anal cancer in women.

Study Location Years of
study		 Population Study design Total no.
of
patients
in cohort		 No (%)
women in
cohort		 Risk factor Anal cancer
incidence (95%
CI) in women
per 100,000
person-years		 Standardized Incidence Ratio (SIR) for Anal
Cancer and other Notable Findings
Blomberg59
Friis60 1 		Denmark 1978 – 2008 Patients with genital warts† Danish National Patient Register 49,088 32,933 (67) Genital warts Not Reported

  • SIR 7.8, 95% CI (5.4–11.0)

  • SIR 21.5, 95% CI (14.4–30.9) in men
Chaturvedi48 Denmark, Finland, Norway, Sweden, US Varies by registry2 One-year survivors of cervical cancer† 13 population based cancer registries from 5 countries 104,760 104,760 (100) Cervical cancer 63.8 (no CI reported)

  • SIR 1.84, 95% CI (1.72–1.98)3
Edgren61 Sweden 1968-2004 Women aged 18-50 with history of CIN 3 Sweden National Registry 3,747,698 All Women CIN 3

  • 6.0 (No CI reported) for patients with CIN

  • 0.96 (No CI reported) for patients w/o hx CIN

  • Adjusted Anal IRR 4.68, 95% CI (3.87–5.62)

  • Risk of anal cancer increases with time since first CIN3 diagnosis, with greatest risk for women with CIN3 diagnosed >10 years

  • Risk of anal cancer increase with younger age at first CIN3 diagnosis
Evans62 UK 1960-1999

  • Women with history of CIN 3†

  • Women with history of invasive cervical cancer†

 Thames Cancer Registry CIN 3: 59,519; Cervical cancer: 21,605 All Women CIN 3 or cervical cancer

  • 4.8 (CIN3) No CI Reported

  • 12.4 (cervical cancer) No CI Reported

  • SIR 5.9, 95% CI (3.7–8.8) for women diagnosed with CIN3

  • SIR 6.3, 95% CI (3.7-10) for women diagnosed with cervical cancer
Nordenvall63 Sweden 1965 – 1999 Hospitalized patients with condylomata acuminata† Sweden inpatient register and nationwide registers 10,971 9,286 (85) Genital warts 4.8 (No CI reported)

  • SIR 9.0, 95% CI (3.6–18.6)
Saleem49 US 1973 – 2007 Patients with either in situ or invasive cervical, vulvar, or vaginal neoplasm† SEER 189,206 All Women HPV-related gynecologic neoplasm 0.8 (No CI reported)

  • Overall SIR 13.6, 95% CI (11.9–15.3)

  • Anal cancer SIRs highest in African American women with invasive vulvar cancer: SIR 45.5, 95% CI (14.3-95.0)

  • Anal cancer SIRs lowest in women with invasive vaginal cancer: SIR 1.8, 95% CI (0.8-5.3)
Hessol50 US 1994-2001 HIV-positive women over the age of 18 Women's Interagency HIV study & SEER 1559 HIV-positive women 391 HIV-negative All Women HIV Not reported

  • HIV-positive: SIR 18.5, 95% CI (0.5–68)

  • HIV-negative: SIR 0, 95% CI (0–289)
Fordyce51 US 1981 – 1994 Women with AIDS, ages 15-69 New York State Cancer Registry and New York City AIDS registry 15,146 All Women HIV Not reported

  • Adjusted SIR 3.23,3 95% CI (1.39-6.36)

  • Unadjusted SIR 2.68,3 95% CI (1.16-5.29)

  • Relative risk increased from 2.35 (early pre-AIDs: 60 to 25 months before AIDS diagnosis) to 5.08 (post-AIDS: 4 to 60 months after AIDS diagnosis)
Franzetti64 Italy 1985-2011 HIV-positive patients† L Sacco Department of Clinical Science at the University of Milan 5,924 1,542 (26) HIV 13.8 (no CI reported)

  • SIR 41.2, 95% CI (4.6 -148.8)

  • Incidence of non-AIDs defining cancers during the HAART period was higher in both women and men

  • Only SIR for vulva was higher in the HAART era for women: SIR 69.2, 95% CI (22.3-61.4)
Frisch (JNCI)52 US 1995 -1998 Patients with HIV/AIDS† AIDS-cancer registry match in 11 state and metropolitan locations4 309,365 51,760 (40) HIV 3.9 (No CI reported)
  • RR of invasive anal cancer
    • Overall (all age groups): RR 6.8, 95% CI (2.7–14)
    • Age at AIDS onset < 30 years: RR 134.3, 95% CI (16.3–484.8) was highest

  • RR for anal cancer similar to those of cervical and vulvar/vaginal cancer
Lanoy65 France 2006 HIV-positive patients with incident cases of cancer† ONCOVIH cohort and FHDH 53,853 Not Reported HIV Not Reported

  • 55 incident cases of anal cancer, 6 in women
Piketty66,67 5 France 1992-2008 HIV positive patients French Hospital Database on HIV 109,771 Not Reported HIV 9.4 (No CI Reported)

  • SIR 13.1, 95% CI (6.7 - 22.8)6

  • In women the Incidence Rates have increased in recent years:
    • 1992-96: 0
    • 1997-2000: IR 6.3, 95% CI (0-13.4)
    • 2001-2004: IR 12.9, 95% CI(4.0-22.0)
    • 2005-2008: IR 18.3, 95% CI(8.0-28.7)
  • In women, SIRs significantly higher at younger than older ages
    • 25–34 yo: IR 83, 95% CI (9-300)
    • 45–54 yo: IR 8, 95% CI (2-17)
Silverberg53 US, Canada 1996-2007 HIV-positive and negative women† NA-ACCORD, SEER 8,842 HIV-positive women 11,653 HIV-negative women 20,495 HIV 30 (17-50)

  • No cases were observed for HIV-negative women

  • Incidence rate was lowest in 1996-1999 (early cART)
    • 1996–99: 0
    • 2000–03: IR 41.5, 95% CI (16.7, 77.4)
    • 2004–07: IR 24.7, 95% CI (9.1, 48.0)
Benard54 US 1998-2003 Incident cases of HPV-associated cancers, Women ≥ 20 years of age CDC, NPCR, SEER, BRFSS data 138,043 95,961 (70) General Population 2.14 (2.10, 2.19)
  • Lower median household income associated with significantly higher rates of anal cancer (compared to areas with income >50,000)
    • <$35,000: IR 2.20, 95% CI (2.11, 2.29)
    • $35,000 - $49,999: IR 2.22, 95% CI (2.17-2.77)
Brewster68 UK 1975-2002 Incident cases of squamous cell carcinoma of the anus† Scottish Cancer Registry Not Reported Not Reported General Population 0.557

  • Significantly higher rates of SCCA in women in economically deprived areas (p = 0.027)

  • Increase in Incidence rates
    • 1970s: IR 0.23 to 0.27
    • 1998 – 2002: IR 0.557
Fisher55 US 1985 -1992 Incident cancers of the lower anogenital tract in women† Michigan Tumor Registry Not Reported Not Reported General Population 0.7 (No CI Reported)

  • Blacks at a similar risk as Whites for anal cancer
Frisch (Cancer)56 US 1973 – 1996 Incident cases of squamous cell carcinoma of cervix, vulva, vagina, anus, penis, and tonsils† SEER (Hawaii and 8 other locations)8 Not Reported Not Reported General Population

  • US whites: 0.9* (No CI reported)

  • Hawaii whites: 1* (no CI reported)

  • Hawaii APIs: 0.4*(No CI reported)
  • SCCA SIR significantly increased over study period only in US whites
    • Estimated annual increase of invasive SCCA 1.5% (p < 0.05)
    • Estimated annual increase of in situ SCCA 4.6% (p < 0.05)
Jin69 Australia 1982-2005 Incident cases of invasive anal cancer† Australian National Cancer Statistics Clearing House database Not Reported Not Reported General Population 1.10 (1.02 – 1.18)*9 Rate adjusted to the 2001 US standard population

  • Incidence of SCCA in women increased by 1.88% per annum, 95% CI (1.18–2.58)

  • annual rate of increase of SCCA was almost 2 times higher in men than in women

  • 5-year survival of invasive anal cancer increased over time, and women had better outcomes than men
Joseph57 US 1998-2003 Incident cases of all types of anal cancer NPCR, SEER (83% of US population) Not Reported Not Reported General Population 1.51 (1.48 –1.54)* rate adjusted to the 2000 US standard population

  • Women had a higher rate of SCCA than men

  • Black women had a significantly RR of SCCA than did white women

  • Rate was significantly higher in the South (RR 1.24, 95% CI [1.66–1.77]) and the West (RR 1.14, 95 % CI [1.51–1.63]) compared with the Northeast

  • Invasive SCCA rates increased significantly from 1992 through 2004, by 2.8%

  • During same period, rate of in situ tumors increased by 4%
Nelson58 10 US 1973-2009 Incident cases of anal adenocarcinoma (AAC) or anal squamous cell carcinoma (SCCA) SEER database Not Reported Not Reported General Population 2.4 (2.3 – 2.5)*11 Rate adjusted to the 2000 US standard population
  • Rates of Anal Adenocarcinoma remained stable, while rates of SCCA were significantly increased in the time period after 1997
    • 1973–1996: SIR 1.4, 95% CI (1.4–1.5)
    • 1997–2009: SIR 2.4, 95% CI (2.3–2.5)
Nielsen70 Denmark 1978 – 2008 Incident cases of anal cancer Danish Cancer Registry and Danish Registry of Pathology 5.5 million Not reported General Population 1.48*12 (No CI reported)

  • 66% of incident cases of anal cancers were in women

  • Average annual percentage change over study period: 2.9%, 95% CI (2.2 – 3.6)

  • Increase in age-adjusted anal cancer SIR was significantly greater in women under 60 years (APC<60 = 5.2%, 95% CI [4.0-6.3]) than in women over 60 (APC>60 = 1.7%, 95% CI [0.9-2.5])

  • 80.7% of cases of anal cancer in women were associated with HPV (compared to 67.9% in men)
Robinson71 UK 1960-2004 Incident cases of anal, vulvar, vaginal, cervical, and penile cancers† Thames Cancer Registry 12 million Not reported General Population 1.18*13 (No CI reported)

  • 2,676 cases of anal cancer in women, 1,988 cases of anal cancer in men

  • Increase in age-standardized period rates in women was greater than that in men
    • In women: 0.45, 95% CI (0.36-0.54) in 1960–64 to 1.18, 95% CI (1.08-1.29) per 100,000 in 2000–2004 (three-fold increase)
    • In men: 0.79, 95% CI (0.64-0.93) in 1960-1964 to 1.06, 95% CI (0.95-1.17) per 100,000 in 2000 - 2004
*

age standardized incidence rate

†

No age range reported

SIR = standardized incidence ratio

1

Data in the table is from 59,60 is a previous analysis of the same data

2

Denmark 1943 – 1998, US SEER 1973 – 2001, Sweden 1958 – 2001, Norway 1953 – 1999, Finland 1953 – 2001

3

Cancers of rectum and anus combined

4

Atlanta, Connecticut, Florida, Illinois, Los Angeles, Massachusetts, New Jersey, New York City/State, San Diego, San Francisco, Seattle

5

Data in the table is from66,67 is a previous analysis of the same data

6

for time period 2005 – 2008

7

for time period 1998 – 2002

8

San Francisco-Oakland, Detroit, Atlanta, Seattle, Connecticut, Iowa, New Mexico, and Utah

9

for the time period 2000 – 2005

10

Data in the table is from58, is a previous analysis of the same data

11

for time period 1997 - 2009

12

for the time period 2003 – 2008

13

for time period 2000 – 2004