Anal cancer risk factors

Prevention

Preventable cases of anal cancer, UK

HPV

Anal cancer cases linked to human papillomavirus (HPV) infection, UK

HIV

Anal cancer cases linked to human immunodeficiency virus (HIV) infection, UK

90% of anal cancer cases each year in the UK are linked to major lifestyle and other risk factors[1].

Anal cancer risk is associated with a number of risk factors.[2,3]

Anal Cancer Risk Factors

  Increases risk Decreases risk
'Sufficient' or 'convincing' evidence
  • Human immunodeficiency virus (HIV) type 1
  • Human papillomavirus (HPV) type 16
 
'Limited' or 'probable' evidence
  • HPV types 18, 33
 

International Agency for Research on Cancer (IARC) classification. World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classification does not include anal cancer because it is not generally recognised to have a relationship to food, nutrition, and physical activity.

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Human papillomavirus (HPV) type 16 is classified by IARC as a cause of anal cancer, and HPV types 18 and 33 are classified as probable causes of anal cancer, based on limited evidence.[1] An estimated 90% of anal cancers in the UK are linked to HPV infection.[2]

Around 91% of anal cancers in women and 75% in men are HPV-positive, a meta-analysis showed.[3]

Anal cancer risk may be higher in people participating in anal sexual behaviours (including but not limited to receptive anal intercourse), accordingly anal cancer risk is higher in men who have sex with men (MSM), compared with other men.[4]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: http://monographs.iarc.fr/ENG/Classification/index.php. Accessed May 2014.
  2. Parkin DM. Cancers attributable to infection in the UK in 2010. Br J Cancer 2011;105(S2):S49-S56.
  3. De Vuyst H, Clifford GM, Nascimento MC, et al. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 2009;124(7):1626-36.
  4. Grulich AE, Poynten IM, Machalek DA, et al. The epidemiology of anal cancer. Sex Health. 2012 Dec;9(6):504-8.
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Human immunodeficiency virus (HIV) type 1 is classified by the International Agency for Research on Cancer (IARC) as a cause of anal cancer.[1] People with HIV infection often also have human papillomavirus (HPV), and HIV may facilitate initiation or persistence of HPV infection; HIV-related UK anal cancer cases are included in the HPV-attributable proportion above.[2]

Anal cancer risk is 28-29 times higher in people with HIV infection, compared with the general population, with no difference between men and women, meta-analyses have shown.[3,4] Anal cancer risk in people with HIV infection may be higher in current smokers, those with concurrent HPV infection, and those with more advanced HIV infection, a nested case-control study showed.[5]

Anal cancer risk is more than 3 times higher in HIV-positive men who have sex with men (MSM) compared with other HIV-positive men, a cohort study showed.[6] Anal cancer incidence is 78 per 100,000 per year in HIV-positive MSMs, compared with 5 per 100,000 per year in HIV-negative MSMs, a meta-analysis has shown.[7]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: http://monographs.iarc.fr/ENG/Classification/index.php. Accessed May 2014.
  2. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  3. Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007;370(9581):59-67.
  4. Shiels MS, Cole SR, Kirk GD, et al. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 2009;52(5):611-22.
  5. Bertisch B, Franceschi S, Lise M, et al. Risk factors for anal cancer in persons infected with HIV: a nested case-control study in the Swiss HIV Cohort Study. Am J Epidemiol 2013;178(6):877-84.
  6. Silverberg MJ, Lau B, Justice AC, et al. Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clin Infect Dis 2012;54(7):1026-34.
  7. Machalek DA, Poynten M, Jin F, et al. Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis. Lancet Oncol 2012;13(5):487-500.
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Anal cancer risk may be higher in smokers compared with non-smokers; the association is probably independent of other risk factors including human papillomavirus (HPV) infection, and may reflect an immunosuppressive effect of smoking.[1]

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Anal cancer risk may be higher in women with a history of vulval or cervical precancerous lesions; these are human papillomavirus-associated (HPV) diseases so the increased anal cancer risk probably reflects this shared aetiology.[1-4]

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