Risk Factors for Anal Dysplasia among Privately Insured HIV-Negative Women

Journal of Cancer Research and Immuno-Oncology is an open access rapid peer reviewed journal in the field of cancer research.

HPV infection is the most commonly diagnosed sexually transmitted disease in the United States (US) and is associated with the development of anal cancer. Anal cancer and its precursor lesions are biologically similar to cervical cancer and caused by persistent HPV infection. A high proportion of anal cancers are associated with HPV types 16 and 18. Each year, there are 1.8 anal cancer cases per 100,000 persons, with a higher incidence among women. The anal cancer incidence has been increasing at a rate of 2.2% per year over the last decade, with death rates rising an average of 1.7% per year. In 2017, there will be 8,200 new anal cancer cases (5,250 in women and 2,950 in men) and 1,100 deaths (650 in women and 450 in men).

Objective: To examine the relationship between anogenital abnormalities and the development of anal dysplasia among Human Immunodeficiency Virus (HIV)-negative women.

Methods: This retrospective matched case-control study used administrative data from the 2009-2014 Clinformatics Data Mart. Cases were selected according to the International Classification of Diseases, Ninth Revision, using Clinical Modification codes for carcinoma in situ of the anal canal or anus unspecified, anal intraepithelial neoplasia 1 and 2, abnormal glandular Papanicolaou (Pap) smear of the anus, or Pap smears of the anus with atypical squamous cells, squamous intraepithelial lesions, or cytological evidence of malignancy. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals for the risk of anal dysplasia.

Results: The study included 3,384 HIV-negative women (846 cases and 2,538 controls), mean age 50.1 ± 11.9 years. The odds of being a smoker, having cervical intraepithelial neoplasia (CIN), or anogenital warts were higher for HIV-negative women with anal dysplasia than for those without anal dysplasia (OR =2.5-16.3).

 Conclusions: HIV-negative women with anal dysplasia are more likely to have concomitant human papillomavirus (HPV)-related CIN and anogenital warts than women without anal dysplasia. The presence of HPV-associated lesions might have implications for future screening recommendations. HIV-negative women with a history of CIN and anogenital warts could benefit from anal dysplasia/anal cancer screening. Gaining a better understanding of the natural history of anal HPV infections will provide tools to better treat and counsel patients with anal dysplasia.

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