Racial/Ethnic Disparities in Survival Among Women Diagnosed with Invasive Cancer of the Anal Canal: an Analysis of Surveillance, Epidemiology, and End Results (SEER) Data.

OBJECTIVE: To identify differences in survival among women diagnosed with cancer of the anal canal from varying racial and ethnic backgrounds. METHODS: Data from the Surveillance, Epidemiology and End Results (SEER) registry between the years of 1975 and 2016 were analyzed, which included 19,048 women with cancer of the anal canal. Multivariable Cox proportional hazard regression (HRs) was performed to examine the relative risk of dying among women with anal cancer. Multivariable odds ratios (ORs) with 95% confidence intervals (CIs) were used to examine odds of highly fatal disease (death within 12 months from diagnosis). RESULTS: Non-Hispanic Black women (n = 1694) had greater risk of dying when compared with non-Hispanic White women (n = 15,821) with anal cancer (HR = 1.26, CI: 1.17-1.35), independent of other prognostic indicators. Stratifying by age at diagnosis, risk of death was highest for non-Hispanic Black women diagnosed younger than age 50 years compared with non-Hispanic White women of similar age (HR = 1.60, CI: 1.34-1.89), and lowest for Hispanic women (n = 1533) older than 74 years at diagnosis (HR = 0.80, CI: 0.69-0.92). Stratifying by stage at diagnosis, disparities were not observed. When comparing across years of diagnoses, non-Hispanic Black women consistently had poorer survival compared with non-Hispanic White women diagnosed in the same year intervals. Finally, non-Hispanic Black women had greater odds of highly fatal disease (OR = 1.23, CI: 1.08-1.40) compared with non-Hispanic White women. CONCLUSION: Non-Hispanic Black women with anal cancer continue to experience poorer survival compared with non-Hispanic White women, whereas disparities were not identified for Hispanic women.

Racial disparities in receipt of standard chemoradiation in anal squamous cell carcinoma, an analysis of the National Cancer Database.

BACKGROUND: Standard treatment for locally advanced anal squamous cell carcinoma (SCC) consists of concurrent chemoradiation. We evaluated whether racial differences exist in the receipt of standard treatment and its association with survival. METHODS: From the National Cancer Database, we identified patients diagnosed with anal SCC (Stages 2-3) between 2004 and 2015. Using logistic regression, we evaluated racial differences in the probability of receiving standard chemoradiation. We used Cox proportional hazards models to evaluate associations between race, receipt of standard therapy and survival. RESULTS: Our analysis included 19,835 patients. Patients receiving standard chemoradiation had better survival than patients receiving nonstandard therapy (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.61-0.68; p < 0.001). Compared to White patients, Black patients were less likely to receive standard therapy (odds ratio [OR] 0.85; 95% CI 0.76-0.96; p < 0.008). We observed no statistical difference in mortality between Black and White patients overall (HR 1.05, 95% CI 0.97-1.15; p = 0.24). However, for the subgroup of patients receiving nonstandard therapy, Black patients had an increased mortality risk compared to White patients (HR 1.17, CI 1.01-1.35; p = 0.034). We observed no survival differences in the subgroup of patients receiving standard treatment (HR 1.00, CI 0.90-1.11, p = 0.99). CONCLUSION: Standard treatment in anal SCC is associated with better survival, but Black patients are less likely to receive standard treatment than White patients. Although Black patients had higher mortality than White patients in the subgroup of patients receiving nonstandard therapy, this difference was ameliorated in the subset receiving standard therapy.

Racial and Ethnic Variation Associated With Human Papillomavirus Genotype in Anal Dysplasia.

BACKGROUND: Human Papillomavirus (HPV) is known to cause dysplasia and cancer. In cervical disease, there are documented differences in prevalence of HPV genotypes among racial/ethnic groups. Little is known about prevalence of HPV genotypes in anal dysplasia. This study aimed to evaluate association between HPV genotypes and race/ethnicity in a racially heterogenous population with anal dysplasia. METHODS: This was a single-institution retrospective review of patients treated for anal dysplasia between 2008 and 2019. HPV genotype, obtained via anal swab testing, was recorded as HPV 16, HPV 18, or other non-16/18 high-risk (HR) HPV genotypes. Univariate and multivariate logistic regression analyses were used to evaluate the association between patient factors and HPV genotype. RESULTS: Of 517 patients meeting inclusion criteria, 46.8% identified as White, 37.1% as Black, 13.2% as Hispanic, and 2.9% as other/unknown. Race/ethnicity (P = 0.016) and sex (P < 0.001) were significantly associated with differences in prevalence of HPV genotypes. Black (odds ratio 1.56, 95% confidence interval 1.00-2.44) and male (odds ratio 2.35, 95% confidence interval 1.42-3.92) patients were significantly more likely to have non-16/18 HR HPV genotypes. CONCLUSIONS: In a racially and socioeconomically diverse cohort of patients with anal dysplasia, Black race and male sex were associated with increased likelihood of infection with a non-16/18 HR HPV genotype. Many of these genotypes are not covered by currently available vaccines. Further study is warranted to evaluate anal HPV genotypes in a larger cohort, as this may have important implications in HPV vaccination and anal dysplasia screening efforts.

Does race impact survival for patients with anal squamous cell carcinoma?

BACKGROUND/OBJECTIVES: Racial disparities are known to impact cancer outcomes. The aim of this study was to assess current racial disparities in outcomes of anal squamous cell carcinoma (SCC). METHODS: The National Cancer Database was used to identify patients with anal SCC. The primary outcome was 5-year overall survival. RESULTS: There were 32 255 (88.1%) White patients and 4342 (11.9%) Black patients identified with anal SCC. Compared to White patients, Black patients were more likely to be younger, have lower median income, and be insured with Medicaid (all P < .001). The 5-year overall survival of Black and White patients for stage I disease was 71.2% and 80.6% (P < .001), for stage II disease, was 64.6% and 69.3% (P = .001), for stage III disease was 50.9% and 58.1% (P < .001), and for stage IV disease was 22.1% and 21.9% (P = .20). In a cox regression analysis, Black race was associated with significantly worse survival in stage I (HR: 1.37, 95% CI: 1.07-1.76, P = .01), stage II (HR: 1.30, 95% CI: 1.14-1.48, P < .001), and stage III disease (HR: 1.31, 95% CI: 1.16-1.47, P < .001) but not for stage IV disease (HR: 1.09, 95% CI: 0.89-1.35, P = .41). CONCLUSIONS: Black race is correlated with worse survival in patients diagnosed with anal SCC. This disparity in survival is likely multifactorial and requires further study.

Human papillomavirus vaccine series completion in boys before and after recommendation for routine immunization.

BACKGROUND: Although the incidence of HPV-attributable cancers in males is rapidly increasing, HPV vaccine uptake in males remains poor. While quadrivalent human papillomavirus vaccine (4vHPV) series initiation in males increased following the Advisory Committee Immunization Practices (ACIP) male routine use recommendation, its impact on 4vHPV series completion in males at ACIP-recommended intervals has not been evaluated in large male cohorts. We examined trends and correlates of 4vHPV completion since licensure in males in a large cohort of insured boys before and after the ACIP routine use recommendation. METHODS: We grouped data from electronic medical records of males aged 9-17years from Kaiser Permanente Southern California health plan who initiated 4vHPV into 3 cohorts by 4vHPV initiation date: licensure and ACIP permissive use: 2009-2010; addition of anal cancer indication: 2010-2011; ACIP routine use: 2011-2013. We estimated adjusted hazard ratios (AHRs) between patient and provider characteristics and vaccination using Marginal Cox proportional hazards models. RESULTS: Of 80,800 boys initiating 4vHPV, 24.3% completed the series within 12months with minimal differences across cohorts. Completion decreased with increasing age at initiation (13-17vs. 11-12year olds: AHR=0.85; 95% confidence interval [CI]=0.80, 0.89) and was greater among patients with a primary care provider (AHR=1.28, 95%CI=1.17, 1.41), influenza vaccine recipients (AHR=1.50, 95% CI=1.43, 1.57), and Asian/Pacific Islanders (AHR=1.07, 95% CI=1.00, 1.15), and lower among non-Hispanic Blacks (AHR=0.72, 95% CI=0.65, 0.80) and Hispanics (AHR=0.86, 95% CI=0.81, 0.90) compared to non-Hispanic Whites. CONCLUSIONS: Despite the ACIP routine use recommendation in males, 4vHPV series completion remained low. 4vHPV initiation at 11-12years and identification of a provider responsible for the adolescents' health care may increase 4vHPV series completion. Given the rapidly increasing incidence of HPV-related cancers in males, it is important to identify measures to increase HPV vaccine series completion, particularly among non-Hispanic Black and Hispanic males.

Conditional Survival in Anal Carcinoma Using the National Population-Based Survey of Epidemiology and End Results Database (1988-2012).

BACKGROUND: Conditional survival can provide valuable information for both patients and healthcare providers about the changing prognosis in surviving patients over time. OBJECTIVE: This study estimated conditional survival for patients with anal cancer in the United States through analysis of a national population-based cancer registry. DESIGN: Log-rank test identified significant covariates of cause-specific survival (defined as time from diagnosis until death from anal cancer). Significant covariates were considered in the multivariable regression of cause-specific survival using Cox proportional hazards models. SETTINGS: Covariates included cancer stage and demographic variables. PATIENTS: Patients in Surveillance, Epidemiology, and End Results regions diagnosed with anal squamous cell carcinoma as their first and only cancer diagnosis from 1988 to 2012 were selected from this database, and 5145 patients were included in the retrospective cohort study. MAIN OUTCOME MEASURE: Five-year conditional survival stratified by each variable in the final Cox models was measured RESULTS: : The final multivariable models of overall and cause-specific survivals included stage, grade, sex, age, race, and relationship status. Over the first 6 years after diagnosis, conditional survival of distant stage increased from 37% to 89%, whereas regional stage increased from 65% to 93% and localized stage increased from 84% to 96%. The other variables had increasing prognosis as well, but the subgroups increased at a more similar rate over time. LIMITATIONS: The data source used does not include information on chemotherapy treatment, patient comorbidities, or socioeconomic status. CONCLUSIONS: Conditional survival showed improvement over time. Patients with advanced stage had the greatest improvement in conditional survival. This is the first study to provide specific conditional survival probabilities for patients with anal cancer.

Clinical Patterns of Melanoma in Asians: 11-Year Experience in a Tertiary Referral Center.

BACKGROUND: Malignant melanoma is a relatively common malignancy in the West, but has a significantly lower incidence in Asians. Stark contrast in clinicopathological characteristics and prognosis has been observed between the 2 populations, yet data are limited. Here, we evaluate 106 Asian patients from a tertiary referral center in Hong Kong during an 11-year period. The purpose of this study was to collectively review all types of melanomas to analyze the clinicopathological characteristics of this poorly understood condition in an Asian population. METHODS: A total of 106 patients diagnosed with malignant melanoma from 2002 to 2012 were retrospectively reviewed. Demographics, clinical presentations, pathological subtypes, treatments, and survival outcomes were evaluated. RESULTS: Cutaneous melanomas dominated with 46 (43.4%) cases, followed by mucosal (39.6%), ocular (9.4%), and melanomas of unknown primary (7.5%); 43.3% patients presented in stage I, 36.7% in stage II, 18.9% in stage III, and 1.1% in stage IV. Acral lentiginous melanoma was the commonest subtype of cutaneous melanomas (60.9%). When types of melanomas were reviewed collectively, the median overall survival, disease-specific survival, and recurrence-free survival were 37, 45, and 48 months, respectively. Cutaneous melanoma had the best median overall survival of 59 months, followed by ocular melanoma (58 months), mucosal melanoma (18 months), and melanoma of unknown primary (2 months). Similar patterns were observed for disease-specific survival and recurrence-free survival. CONCLUSIONS: Melanoma among Asians remains poorly understood. There is a clear distinction in the clinical patterns between Asians and whites and the difference is not solely accounted for by the lower incidence of cutaneous melanoma. Certain subtypes, such as mucosal melanoma and is acral lentiginous melanoma, seemed to have disproportionately high incidences. Further studies are warranted to elucidate these observations. The poor survival outcomes reflected the need for better awareness and understanding of the condition by both the general public and the physicians.

Systematic review of racial disparities in human papillomavirus-associated anal dysplasia and anal cancer among men who have sex with men.

We systematically reviewed the literature on anal human papillomavirus (HPV) infection, dysplasia, and cancer among Black and White men who have sex with men (MSM) to determine if a racial disparity exists. We searched 4 databases for articles up to March 2014. Studies involving Black MSM are nearly absent from the literature. Of 25 eligible studies, 2 stratified by race and sexual behavior. Both reported an elevated rate of abnormal anal outcomes among Black MSM. White MSM had a 1.3 times lower prevalence of group-2 HPV (P < .01) and nearly 13% lower prevalence of anal dysplasia than did Black MSM. We were unable to determine factors driving the absence of Black MSM in this research and whether disparities in clinical care exist. Elevated rates of abnormal anal cytology among Black MSM in 2 studies indicate a need for future research in this population.

Anal cancer incidence and mortality in Puerto Rico.

OBJECTIVE: Anal cancer is a rare tumor that is associated with oncogenic HPV genotypes. This study aims to compare the age-standardized rates (ASRs) of anal cancer incidence and mortality in men and women living in Puerto Rico (PR) with those of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanics (USH) living in the continental United States (US). METHODS: ASRs were calculated based on cancer data that came from the PR Cancer Central Registry and from the Surveillance, Epidemiology, and End Results (SEER) program. The age-specific relative risks (RR) and 95% Confidence Interval (95% CI) were estimated using Poisson regression models. RESULTS: Comparing the period of 2001 to 2004 to that of 1992 to 1996, the incidence of anal cancer increased among NHW, NHB, and PR men. In females, an increase in the incidence was observed for all racial groups except for Puerto Rican women. When evaluating findings by age groups, Puerto Rican men younger than 60 years old had a 20% higher incidence of anal cancer than did USH men of the same age strata (RR: 2.20; 95% CI = 1.48-3.29). However, Puerto Rican females had a lower incidence of anal cancer than NHW and NHB women. An increased percent change in mortality was observed only in NHW and NHB men. A decreasing trend was observed in all racial/ethnic groups except for NHW women. CONCLUSION: Our results support the notion that there are racial/ethnic differences in anal cancer incidence and mortality, with potential disparities among men and women in PR compared with USH men and women. Given the increasing incidence trends in anal cancer, particularly among PR, NHW, and NHB men, further investigation is needed to better elucidate screening practices that can aid in the prevention of anal cancer.

Anal canal malignancies: a review in an Asian population.

INTRODUCTION: Anal canal malignancies are rare tumours of the gastrointestinal tract that represent less than five percent of anorectal malignancies. METHODS: We retrospectively reviewed patients with anal canal malignancies who were treated from April 1989 to December 2008. Patients were identified from a prospective database and records were analysed for age, gender, presenting symptoms, duration of symptoms, mode of diagnosis, histological subtypes, stage of disease, treatment received, duration of follow-up, recurrence rates and survival. RESULTS: A total of 61 patients were treated for anal canal malignancies, comprising 2.1 percent of all anorectal malignancies treated during the same period. There were 31 male and 30 female patients, with a median age at diagnosis of 61 (range 38-83) years. The commonest presenting symptoms were per rectal bleeding (69.4 percent) and pain (33.9 percent). The commonest histology was adenocarcinoma (50.8 percent) and squamous cell carcinoma (SCC) (40.3 percent). Patients underwent either surgery, radiotherapy, chemoradiation or a combination of modalities. The median duration of follow-up was 28 (range 1-120) months. Five patients developed recurrences after a median of 23 (range 2-36) months. The five-year overall survival and disease-free survival was 65.5 percent and 63.7 percent, respectively, with SCC showing a trend toward a better prognosis. CONCLUSION: Anal canal tumours are a rare clinical entity. They are usually present in the elderly with per rectal bleeding. They are usually treated using a multimodality approach, after the accurate establishment of histological diagnosis, which can yield reasonable survival rates.

Current therapeutic strategies for anal squamous cell carcinoma in Japan.

BACKGROUND: In Western countries, chemoradiotherapy (CRT) is well established as the standard therapy for stages II/III anal squamous cell carcinoma (ASCC). In Japan, the therapeutic modalities for and outcomes of this disease have not been clarified because ASCC is quite rare. The Colorectal Cancer Study Group of the Japan Clinical Oncology Group (JCOG-CCSG) conducted a survey to determine the current therapeutic strategies for ASCC in Japan. METHODS: In July 2006, a questionnaire was sent to 49 institutions affiliated with the JCOG-CCSG to gather information on numbers of cases, therapeutic modalities, and outcomes. The target subjects were patients with stages II/III ASCC, diagnosed from January 2000 to December 2004, who were 20-80 years of age with normal major organ function and no severe complications. RESULTS: Replies were received from 40 institutions. A total of 59 patients satisfied the subject criteria. Detailed information was obtained for 55 subjects; 25 (45%) had stage II ASCC and 30 (55%) had stage III ASCC. CRT was performed in 25 patients (45%); surgery in 17 (31%); surgery combined with radiotherapy (RT), chemotherapy, or CRT in 8 (15%); and RT in 5 (9%). Complete response rate in CRT was 80% (20/25). The 3-year progression-free survival rates for all subjects and for CRT-only subjects were 67% and 77%, respectively. CONCLUSION: From 2000 to 2004, only 59 patients with ASCC were identified in the JCOG-CCSG survey and about half of them underwent CRT.

Understanding the burden of human papillomavirus-associated anal cancers in the US.

BACKGROUND: Anal cancer is an uncommon malignancy in the US; up to 93% of anal cancers are associated with human papillomavirus. METHODS: Cases diagnosed between 1998 and 2003 from 39 population-based cancer registries were analyzed. The following anal cancer histologies were included in the analysis: squamous cell, adenocarcinoma, and small cell/neuroendocrine carcinomas. Incidence rates were age-adjusted to the 2000 US standard population. RESULTS: From 1998 through 2003, the annual age-adjusted invasive anal cancer incidence rate was 1.5 per 100,000 persons. Squamous cell carcinoma (SCC) was the most common histology overall, accounting for 18,105 of 21,395 (84.6%) cases of anal cancer. Women had a higher rate of SCC (1.5 per 100,000) than men (1.0). Whites and blacks had the highest incidence rate (1.3), whereas Asians/Pacific Islanders (API) had the lowest rate (0.3). Incidence rates of anal SCC increased 2.6% per year on average. The majority of SCC cases were diagnosed at the in situ or localized stage (58.1%). API were more likely to be diagnosed with regional or distant stage disease than were other racial/ethnic groups (27.5% and 11.8%, respectively). Males had lower 5-year relative survival than females for all stages of disease. CONCLUSIONS: Rates of anal SCC varied by sex, race, and ethnicity. A higher proportion of API were diagnosed at regional/distant stage. Men had lower 5-year survival rates than women. Continued surveillance and additional research are needed to assess the potential impact of the HPV vaccine on the anal cancer burden in the US.

Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973-2000.

BACKGROUND: Anal cancer is a rare malignancy of the anogenital tract that historically has affected women at a greater rate than men. METHODS: The authors analyzed changing trends in incidence rates and 5-year relative survival percentages for patients with anal cancer. The publicly available data used in the current study were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program, a system of population-based tumor registries in the United States. RESULTS: The incidence of anal cancer was similar for men and women between 1994 and 2000 (2.04 per 100,000 and 2.06 per 100,000, respectively), the most recent period for which data were available, whereas men had lower rates than did women between 1973 and 1979 (1.06 per 100,000, compared with 1.39 per 100,000), the earliest period for which data were available. In addition, recently, black men had higher incidence rates than did other race-specific and gender-specific groups (2.71 per 100,000). From the earliest period for which data were available to the most recent period, relative 5-year survival improved from 59% to 73% among women, was unchanged among men ( approximately 60%), and decreased from 45% to 27% among black men. Eighteen percent of patients who had distant disease were alive at 5 years, compared with 78% of patients who had localized disease. CONCLUSIONS: The incidence of anal cancer in the United States increased between 1973 and 2000, particularly among men. There were higher incidence rates and lower survival rates for black men compared with other race-specific and gender-specific groups. Later disease stage was inversely associated with the survival rate, indicating that earlier detection may improve the survival of patients with anal cancer.

Anal canal cancer: a population-based reappraisal.

PURPOSE: This study was designed to obtain an updated population-based perspective on anal canal cancer incidence rates, demographics, and outcomes using a nationwide database. Eight-five percent of all carcinomas of the anus are anal canal cancers, and previous studies suggest that incidence rates may be rising. Although the most successful treatment for anal canal cancer has been chemoradiation, little information at the population-level exists regarding demographics, treatment, and survival. METHODS: All patients diagnosed with anal canal cancer from 1973 to 1998 in the Surveillance Epidemiology and End Results cancer registry were analyzed. Data regarding demographics, cancer characteristics, treatment, and survival were assessed. Univariate and multivariate survival analyses were performed. RESULTS: A total of 4,841 patients were studied (mean age was 61 years; 62 percent female). Female patients were significantly older than male patients (65 vs. 58 years; P < 0.0001). There was a yearly increase in incidence of anal canal cancers (from 1973-1998). Disease prevalence by stage was localized (53 percent), regional (38 percent), and distant (9 percent). Racial/stage differences were seen, because black patients had less localized disease than white patients (46 vs. 53 percent; P < 0.01). Overall five-year survival for the entire cohort was 53 percent, and cancer-specific survival was 84 percent. Survival improved per decade (based on year of diagnosis). Significant survival differences in race were noted, but were less when the receipt of treatment was considered. CONCLUSION: Although most anal canal cancer reviews are single institutional series, this study was performed with population-based data. The incidence of anal canal cancer is increasing, and overall survival rates are improving. Important disparities in care were identified, which need to be addressed.

Incidence of anal cancer in California: increased incidence among men in San Francisco, 1973-1999.

BACKGROUND: Incidence of anal cancer has increased in the United States during the past 30 years. This report describes the incidence of this rare cancer in the diverse California population. METHODS: Age-adjusted incidence rates (AAIR) were calculated by gender, race/ethnicity, county, and year of diagnosis for over 2100 cases of cancer of the anus diagnosed between 1995 and 1999. Age-adjusted incidence rates by time period 1973-1999 were calculated for San Francisco County. RESULTS: Age-adjusted incidence was higher for women than for men (AAIR 1.5 vs 1.2) in California, but men under age 40 and those classified as non-Hispanic Black had higher rates than women, and men had higher rates in San Francisco County (AAIR=8.7). Rates were higher among non-Hispanic Blacks and Whites than among Hispanics and Asian/Pacific Islanders. For all of California, there was an average 2% annual increase among non-Hispanic White men between 1988 and 1999. Incidence of this cancer among White males residing in San Francisco County more than doubled between the 1984-1990 and 1996-1999 time periods. Rates rose especially dramatically for San Francisco men ages 40 to 64, from 3.7 cases per 100,000 in 1973-1978 to 8.6 cases per 100,000 in 1984-1990 and to 20.6 cases per 100,000 in 1996-1999. CONCLUSIONS: Elevated incidence of anal cancer among White men residing in San Francisco County is likely to be related to the high proportion of men who have sex with men. Rates of anal cancer in this high-risk population increased during the past decade.

Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome.

BACKGROUND: Human papillomavirus (HPV)-associated anogenital malignancies occur frequently in patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). The purpose of our study was to determine if the high frequency of these cancers is due to lifestyle factors associated with both HPV and HIV infections or to immunosuppression following HIV infection. METHODS: We studied invasive and in situ HPV-associated cancers among 309 365 U.S. patients with HIV infection/AIDS (257 605 males and 51 760 females) from 5 years before the date of AIDS onset to 5 years after this date. Sex-, race-, and age-standardized ratios of observed-to-expected cancers served as measures of relative risk (RR). Trend tests were used to evaluate changes in the RRs during the 10 years spanning AIDS onset. All statistical tests were two-sided. RESULTS: All HPV-associated cancers in AIDS patients occurred in statistically significant excess compared with the expected numbers of cancers. For in situ cancers, overall risks were significantly increased for cervical (RR = 4.6; 95% confidence interval [CI] = 4.3-5.0), vulvar/vaginal (RR = 3.9; 95% CI = 2.0-7. 0), anal (in females, RR = 7.8 [95% CI = 0.2-43.6]; in males, RR = 60.1 [95% CI = 49.2-72.7]), and penile (RR = 6.9; 95% CI = 4.2-10.6) cancers, and RRs increased during the 10 years spanning AIDS onset for carcinomas in situ of the cervix (P: for trend <.001), vulva/vagina (P: for trend =.04), and penis (P: for trend =.04). For invasive cancers, overall risks were significantly increased for cervical (RR = 5.4; 95% CI = 3.9-7.2), vulvar/vaginal (RR = 5.8; 95% CI = 3.0-10.2), and anal (RR = 6.8; 95% CI = 2.7-14.0) cancers in females and for anal (RR = 37.9; 95% CI = 33.0-43.4), penile (RR = 3. 7; 95% CI = 2.0-6.2), tonsillar (RR = 2.6; 95% CI = 1.8-3.8), and conjunctival (RR = 14.6; 95% CI = 5.8-30.0) cancers in males. However, RRs for invasive cancers changed little during the 10 years spanning AIDS onset. CONCLUSIONS: HPV-associated malignancies occur at increased rates in persons with HIV/AIDS. Increasing RRs for in situ cancers to and beyond the time of AIDS onset may reflect the gradual loss of control over HPV-infected keratinocytes with advancing immunosuppression. However, the lack of a similar increase for invasive HPV-associated cancers suggests that late-stage cancer invasion is not greatly influenced by immune status.

Human papillomavirus-associated carcinomas in Hawaii and the mainland U.S.

BACKGROUND: To the authors' knowledge, human papillomavirus (HPV)-associated carcinomas in Hawaii have not been studied in detail. METHODS: Surveillance, Epidemiology, and End Results data (from 1973-1996) were used to study rate of incidence patterns of squamous cell carcinomas (SCCs) of the uterine cervix, vulva/vagina, anus, penis, and palatine tonsils among Asian/Pacific Islanders and whites in Hawaii and among whites in the U.S. in general. RESULTS: With the exception of invasive cervical SCC, male and female Asian/Pacific Islanders in Hawaii had considerably lower incidence rates of HPV-associated SCCs than Hawaii whites and U.S. whites. Among women, Hawaii whites and U.S. whites had rather similar rates of invasive anogenital and tonsillar SCCs, but in situ SCC of the cervix or vulva/vagina was diagnosed less often among Asian/Pacific Islanders and whites in Hawaii than among whites in the general U.S. Among men, Hawaii whites had higher rates than U.S. whites of both anal and tonsillar, but not penile, SCCs. Among Hawaiian men with anal carcinoma, 43% (15 of 35) had remained unmarried versus 3% (2 of 65) of Hawaiian women with anal carcinoma. CONCLUSIONS: Asian/Pacific Islanders in Hawaii generally have lower incidence rates of HPV-associated SCCs than whites. However, low ratios of in situ to invasive cervical SCCs suggest that many Hawaii women, notably Asian/Pacific Islanders, are not diagnosed and treated for cervical neoplasias at a preinvasive stage. The high rate of incidence of anal SCC in male Hawaiian whites and the high proportions of unmarried men among patients with this disease suggest the transmission of HPV through homosexual contact. These men may be targeted in future screening programs for anal carcinoma.