Sexually Transmitted Infection and Anal Cancer
Although epidermoid anal cancer, a neoplasm of the anal canal and perianal skin lining, is somewhat rare, its incidence has recently substantially increased, especially among women and unmarried men. As early as the 1940s, an association was noted between STDs, homosexual contact, and anal cancer. Observations also link cervical cancer with anal cancer. Since HPV is a primary agent in cervical cancer, the authors of this population-based case-control study examined all cases of anal cancer from 1991 to 1995 in Denmark and Sweden.
There was a strong correlation between lifetime number of sexual partners and risk of anal cancer: women with 10 or more lifetime partners had five times greater relative risk than women with one partner. Women with anal warts had a 9.8 odds ratio for anal cancer compared to women without warts. Homosexual and bisexual men, and those with increased numbers of sexual partners, had markedly increased odds ratios for anal cancer.
The authors note that the annual incidence of anal cancer has increased from two to seven per million person-years in Denmark. The authors note that these increases may be related to changes in sexual practices, including increasing numbers of partners, homosexual contact, and anal warts. In particular, HPV types 6, 11, 16, and 18 have been found in more than two-thirds of patients with anal cancer in both genders. The authors conclude that factors associated with increased risk for anal cancer include large number of sexual partners, young age at time of first intercourse, receptive anal intercourse, and unmarried status.
Frisch M, et al. N Engl J Med 1997; 337:1350-1358.
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