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Rates of anal cancer and mortality soar in the United States



Researchers have studied the trends of anal cancer cases over the past 15 years and identified about 69,000 cases of anal cancer and more than 12,000 deaths during this time.

"Our findings of a dramatic increase in the incidence of black millennia and white women, rising rates of disease distress and an increase in cancer mortality rates are very worrying," study lead author Ashish A. Desmuk, assistant professor The UTEF School of Public Health said in a statement. "Given the historical perception that anal cancer is rare, it is often overlooked."

Distant disease is when cancer spreads to other parts of the body.

From 2001 to 2015, the most common types of anal cancer increased by 2.7% annually, while the death rate of anal cancer increased by 3.1% annually from 2001 to 2016.

The study, published in the Journal of the National Cancer Institute, "gives numbers of a trend that seems to be happening in the last decade," said Dr. Virginia Schaefer, colorectal surgeon and associate professor at the Winship University Cancer Institute. "In that sense it gives us numbers of what we already expected." Schafer was not included in the study.

HPV-related cancer

Anal cancer occurs where the digestive tract ends. It is different from colon or rectal cancer and most similar to cervical cancer.

The most common subtype of anal cancer is squamous cell carcinoma, caused by human papillomavirus, known as HPV.

Over 90% of cases of anal cancer are HPV-related, according to the US Centers for Disease Control and Prevention.
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Screening for anal cancer has been conducted for some high-risk groups, but the study's authors argue that their findings suggest "wider screening efforts should be considered." But they also believe that the rise in diagnoses is unlikely to be due to an increase in screening practices.
Since the 1950s, there have been significant changes in risk factors for anal cancer, including shifts in sexual behavior and an increased number of sexual partners, according to the study, both increasing the likelihood of contractual HPV.
The emergence of the HIV epidemic, especially in men who have sex with men, may also influence the trends in anal cancer, as HIV is a risk factor.
There are other risk factors, too, such as cervical cancer or vulvar, who have received an organ transplant or current smoker.

Who is affected by anal cancer?

The study showed that the incidence of anal cancer was significantly increased in people aged 50 and over.

Perhaps this is because the HPV vaccination guidelines are "very tight", Schafer said, limiting protection for older adults. When the first HPV vaccine was introduced in 2006, it was approved for people between the ages of 9 and 26, "so these older adults were far from being cut off when the vaccine came out," Schafer said. "It's a large number of people who have failed to receive the vaccine."
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Rates of anal cancer are also rising in young blacks.

HIV also disproportionately affects young blacks, the study's authors say, and that HIV is a risk factor for anal cancer.

The study also found that the number of advanced stage patients was increasing. This may be partly because HIV treatment is improved, Schafer said, which means patients live longer with compromised immune systems, and cancer can progress further until it is diagnosed.

Stopping the stigma

There is still a stigma around anal cancer.

Desperate Housewives star Marcia Kroes opened up about her diagnosis of anal cancer earlier this year to help destigmatize the disease, she said.

"I know there are people who are ashamed," Kroes told the CBS this morning in June. "You have cancer. Do you then also feel like ashamed how you did something wrong because it took up residence in your anus? “

Anal cancer has become "pretty taboo", said Schafer, "I think because of some of the risk factors that were known to be historically related to it.

"If people have symptoms, they should go to a doctor because I think a lot of people think, 'Oh, well, it's just hemorrhoids' and don't check things out and that can potentially mean that you aren't diagnosed until much, much later “.

Anal cancer can be prevented by HPV vaccination. The CDC recommends two doses of the vaccine a year for children ages 11 to 12 in the United States. Young adults up to 26 years of age can also be vaccinated. Elderly adults should talk to their doctor as the vaccine is most useful when administered at a younger age before the person is exposed to HPV.

To bolster prevention efforts forward, Schafer said that all people who are eligible to be vaccinated should do so and that current vaccination guidelines should be studied to determine if they can be extended to other patients.

CNN's Michael Nedelman, Lisa Reapers France and Sandy Lamoth contributed to this report.


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