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Risk of Anal Cancer in Women With a Human Papillomavirus–Related Gynecological Neoplasm

Puerto Rico 1987–2013

Acevedo-Fontánez, Adrianna I. MS1; Suárez, Erick PhD1; Torres Cintrón, Carlos R. MPH2; Ortiz, Ana P. PhD1,3

Journal of Lower Genital Tract Disease: July 2018 - Volume 22 - Issue 3 - p 225–230
doi: 10.1097/LGT.0000000000000395
Original Research Articles: Cervix and HPV
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Objective The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR).

Materials and Methods We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987–2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer.

Results A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non–HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79).

Conclusions Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non–HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.

1Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico;

2Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; and

3Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico

Reprint requests to: Ana Patricia Ortiz, PhD, University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, Department of Biostatistics and Epidemiology, P.O. Box 365067, San Juan, Puerto Rico 00936-5067. E-mail: ana.ortiz7@upr.edu

This project was approved by the institutional review board of the University of Puerto Rico, Medical Sciences Campus.

A.P.O. had a research grant with Merck Co. The others authors have declared they have no conflicts of interest.

The collection of cancer incidence data by the Puerto Rico Central Cancer Registry (PRCCR), as part of the statewide cancer reporting program mandated by the Puerto Rico State Law No. 28 of March 20, 1951, and Law No. 113 of July 30, 2010 (Law of the Puerto Rico Central Cancer Registry), was supported, in part, by the National Program of Cancer Registries (NPCR) (NPCR Award Number 5U58-DP 003863–05) of the Centers for Disease Control and Prevention (CDC). The ideas and opinions expressed herein are those of the author(s) and endorsement by the PRCCR is not intended, nor should be inferred.

Copyright © 2018 by the American Society for Colposcopy and Cervical Pathology