Trends in anal cancer in Australia, 1982–2005
Introduction
About 90% of anal squamous cell carcinoma (SCC) cases are caused by high risk types of human papillomavirus (HPV) infection, and HPV-16 alone causes 90% of cases that are HPV attributed [1], [2], [3], [4], [5]. Prophylactic HPV vaccination against HPV-16 and HPV-18 has been shown to be highly effective in preventing cervical dysplasia and thus cervical cancer [6], [7]. Recently, the quadrivalent HPV vaccine has also been shown to be highly effective in preventing HPV-16 and HPV-18 associated anal dysplasia [8], and thus may prevent a large proportion of cases of anal SCC [9], [10]. Anal adenocarcinoma represents less than 30% of anal cancer in most industrialised nations, but in some other regions comprises a majority of cases. The aetiology of anal adenocarcinoma has been little studied, and thus it has been recommended that this condition should be analysed separately from anal SCC [11].
To estimate the benefits that could be yielded through a vaccination program or screening program to prevent anal cancer in Australia, it is essential that the burden of the disease be fully captured. Anal cancer is an uncommon malignancy in most populations, with age standardised incidence of generally less than 2/100,000. However, the incidence of anal cancer has steadily increased in both men and women in the US and the UK over the past three decades [12], [13], [14], [15]. The five-year survival from anal cancer in the US has increased in recent years to over 70%. Survival is highly dependent on stage at diagnosis, rising from 36% when there has been distant spread to 80% when the disease is localised [12], [13].
In this report, we examine the incidence of invasive anal cancer and its five-year survival in Australia between 1982 and 2005.
Section snippets
Incidence
Incidence of invasive cancer was determined from the National Cancer Statistics Clearing House database (NCSCH). The NCSCH was established in 1986 to co-ordinate cancer statistics on a national basis at the Australian Institute of Health and Welfare (AIHW) and collates cancer notification data from all eight Australian state and territory cancer registries, thus providing cancer notification statistics for the entire Australian population.
The analyses were performed on records of cancer cases
Results
From 1982 to 2005, there were a total of 4615 invasive anal cancer cases diagnosed in Australia. This increased from an average of 118 per annum in the 1982–1987 period to 271 per annum in the 2000–2005 period (Table 2). The majority of the anal cancer cases was SCC (69.7%), and this remained stable over time. Anal adenocarcinomas comprised 26.5%. Compared with women, men had lower proportions of SCC and higher proportions of adenocarcinoma. The rates of anal SCC were higher in woman than in
Discussion
Nearly 70% of the invasive anal cancers diagnosed in Australia were SCCs. Between 1982 and 2005, the annual incidence of anal SCC increased almost 50%, from 0.65/100,000 to 1.00/100,000. Incidence increased at all ages. Although rates were in general higher in women, the annual rate of increase was almost twofold higher in men. In both men and women, the risk of developing anal SCC increased greatly with age. Five-year relative survival from anal SCC increased by almost 10% over the period of
Acknowledgments
The authors wish to thank Dr. Mark Short, from the Health Registers and Cancer Monitoring Unit, Australian Institute of Health and Welfare, for provision of data stored in the National Cancer Statistics Clearing House database.
Competing interest: Dr. E. Lynne Conway and Dr. Alicia Stein are employed by CSL Limited and own stock in CSL Limited. Funding: The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing. The views
References (37)
- et al.
Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial
Lancet
(2007) - et al.
How has the sexual behaviour of gay men changed since the onset of AIDS: 1986–2003
Aust N Z J Public Health
(2005) - et al.
Sex in Australia: first experiences of vaginal intercourse and oral sex among a representative sample of adults
Aust N Z J Public Health
(2003) - et al.
Sex in Australia: heterosexual experience and recent heterosexual encounters among a representative sample of adults
Aust N Z J Public Health
(2003) - et al.
Incidence of anal cancer in California: increased incidence among men in San Francisco, 1973–1999
Prev Med
(2003) - et al.
Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis
Lancet
(2007) - et al.
The cervical cancer epidemic that screening has prevented in the UK
Lancet
(2004) - et al.
Sexually transmitted infection as a cause of anal cancer
N Engl J Med
(1997) - et al.
Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer
Cancer
(2004) - et al.
Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions
Int J Cancer
(2009)
The relationship of human papillomaviruses to anorectal neoplasia
Cancer
Cancers attributable to human papillomavirus infection
Sex Health
Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions
N Engl J Med
Quadrivalent HPV vaccine efficacy against anal intraepithelial neoplasia in men having sex with men
On the etiology of anal squamous carcinoma
Dan Med Bull
HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women
Cancer
Anal cancer
Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000
Cancer
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