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Diagnosis, Treatment, and Prevention of Anal Cancer

  • HIV/AIDS (RD MacArthur, Section Editor)
  • Published:
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Abstract

Rare in the general population, anal cancer has reached epidemic proportions among HIV-infected men who have sex with men (MSM). These cancers are human papillomavirus (HPV)-associated, usually HPV type16, and are analogous to cervical cancer. At present, the rates of anal cancer in this group are 10-fold higher than that of cervical cancer occurring in women in the general population. Although there are no national guidelines for screening for anal intraepithelial dysplasia (AIN), many large HIV clinics are now performing anal cytologic screening in their at-risk patients. This paper outlines the current approach to screening for AIN and its management.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. http://seer.cancer.gov/statfacts/html/anus.html#incidence-mortality Last accessed 11/4/2011

  2. Chiao EY, Krown SE, Stier EA, Schrag D. A population-based analysis of temporal trends in the incidence of squamous anal canal cancer in relation to the HIV epidemic. J Acquir Immune Defic Syndr. 2005;40:451–5.

    Article  PubMed  Google Scholar 

  3. Ryan DP, Compton CC, Mayer RJ. Review article: carcinoma of the anal canal. New Engl J Med. 2000;342:792–800.

    Article  PubMed  CAS  Google Scholar 

  4. Chin-Hong PV, Vittinghoff E, Cranston RD, Buchbinder S, Cohen D, Colfax G, et al. Age-specific prevalence of anal human papillomavirus infection in HIV-negative sexually active men who have sex with men: the EXPLORE study. J Infect Dis. 2004;190:2070–6.

    Article  PubMed  Google Scholar 

  5. de Pokomandy A, Rouleau D, Ghattas G, Vezina S, Cote P, Macleod J, et al. Prevalence, clearance, and incidence of anal human papillomavirus infection in HIV-infected men: the HIPVIRG cohort study. J Infect Dis. 2009;199:965–73.

    Article  PubMed  Google Scholar 

  6. Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus associated Cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst. 2000;92:1500–10.

    Article  PubMed  CAS  Google Scholar 

  7. Goldie SJ, Kuntz KM, Weinstein MC, Freedberg KA, et al. Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus–negative homosexual and bisexual men. Amer J Med. 2000;108:634–41.

    Article  PubMed  CAS  Google Scholar 

  8. •• Palefsky J. Human Papillomavirus and Anal Neoplasia. Current HIV/AIDS Reports 2008 5: 78–85. An overview of HPV and anal cancer authored by a leader in the field.

  9. Crum-Cianflone NF, Hullsiek KH, Marconi VC, Ganesan A, Weintrob A, Barthel RV, et al. Anal cancers among HIV-infected persons: HAART is not slowing rising incidence. Aids. 2010;24(4):535–43.

    Article  PubMed  Google Scholar 

  10. Zanet E, Berretta M, Martellotta F, Cacopardo B, Fisichella R, Tavio M, et al. Anal cancer: focus on HIV-positive patients in the HAART-era. Curr HIV Res. 2011;9(2):70–81.

    Article  PubMed  CAS  Google Scholar 

  11. Kreuter A, Potthoff A, Brockmeyer NH, Gambichler T, Swoboda J, Stucker M, et al. Anal carcinoma in human immunodeficiency virus-positive men: results of a prospective study from Germany. Br J Dermatol. 2010;162(6):1269–77.

    Article  PubMed  CAS  Google Scholar 

  12. Chin-Hong PV, Husnik M, Cranston RD, Colfax G, Buchbinder S, Da Costa M, et al. Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men. AIDS. 2009;23:1135–42.

    Article  PubMed  Google Scholar 

  13. Human papillomaviruses. In IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol 90. Lyon, France: International Agency for Research on Cancer; 2007:209–222

  14. Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part II J Am Acad Dermatol. 1999;41:661–77.

    Article  CAS  Google Scholar 

  15. •• Stanley M. Immune responses to human papillomavirus. Vaccine 2006; 24S1:S1/16-S1/22. A comprehensive review of HPV immunology.

  16. Syrjanen S. Human papillomavirus infection and its association with HIV. Adv Dent Res. 2011;23:84–9.

    Article  PubMed  CAS  Google Scholar 

  17. Watson AJ, Smith BB, Whitehead MR, Sykes PH, Frizelle FA. Malignant progression of anal intra-epithelial neoplasia. ANZ J Surg. 2006;76:715–7.

    Article  PubMed  Google Scholar 

  18. Palefsky JM, Holly EA, Ralston ML, Jay N, Berry JM, Darragh TM. High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men. AIDS. 1998;12:495–503.

    Article  PubMed  CAS  Google Scholar 

  19. Palefsky JM, Holly EA, Efirdc JT, Da Costa M, Jay N, Berry JM, et al. Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men. AIDS. 2005;19:1407–14.

    Article  PubMed  Google Scholar 

  20. de Pokomandy A, Rouleau D, Ghattas G, Trottier H, Vezina S, Cote P, et al. HAART and progression to high-grade anal intraepithelial neoplasia in men who have sex with men and are infected with HIV. Clin Infect Dis. 2011;52:1174–81.

    Article  PubMed  Google Scholar 

  21. Conley L, Bush T, Darragh TM, Palefsky JM, Unger ER, Patel P, et al. Factors associated with prevalent abnormal anal cytology in a large cohort of HIV-infected adults in the United States. J Infect Dis. 2010;202:1567–76.

    Article  PubMed  CAS  Google Scholar 

  22. http://www.hivguidelines.org/clinical-guidelines/adults/neoplastic-complications-of-hiv-infection/ Last accessed 11/4/2011

  23. Abramowitz L, Benabderrahmane D, Ravaud P, et al. Anal squamous intraepithelial lesions and condyloma in HIV-infected heterosexual men, homosexual men and women: prevalence and associated factors. AIDS. 2007;21:1457–65.

    Article  PubMed  Google Scholar 

  24. Ortoski RA, Kell CS. Anal cancer and screening guidelines for human papillomavirus in men. J Am Osteopath Assoc. 2011;111(3 Suppl 2):S35–43.

    PubMed  Google Scholar 

  25. Chin-Hong PV, Berry JM, Cheng SC, Catania JA, Da Costa M, Darragh TM, et al. Comparison of patient- and clinician-collected anal cytology samples to screen for human papillomavirus-associated anal intraepithelial neoplasia in men who have sex with men. Ann Intern Med. 2008;149:300–6.

    PubMed  Google Scholar 

  26. • Oon SF, Winter, DC. Perianal condylomas, anal squamous intraepithelial neoplasms and screening: a review of the literature. J Med Screening 2010; 17:44–49. Current review of where we stand on screening for AIN

  27. Chiao EY, Giordano TP, Palefsky JM, Tyring S, El Serag H. Screening HIV-infected individuals for anal cancer precursor lesions: a systematic review. Clin Infect Dis. 2006;43:223–33.

    Article  PubMed  Google Scholar 

  28. Palefsky JM, Holly EA, Hogeboom CJ, Berry JM, Jay N, Darragh TM. Anal cytology as a screening tool for anal squamous intraepithelial lesions. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;14:415–22.

    Article  PubMed  CAS  Google Scholar 

  29. Swedish KA, Lee EQ, Goldstone SE. The changing picture of high-grade anal intraepithelial neoplasia in men who have sex with men: the effects of 10 years of experience performing high-resolution anoscopy. Dis Colon Rectum. 2011;54:1003–7.

    Article  PubMed  Google Scholar 

  30. Scholefield JH, Harris D, Radcliffe A. Guidelines for management of anal intraepithelial neoplasia. Colorectal Dis. 2011;13 Suppl 1:3–10.

    Article  PubMed  Google Scholar 

  31. Pineda CE, Berry JM, Jay N, Palefsky JM, Welton ML. High-resolution anoscopy targeted surgical destruction of anal high-grade squamous intraepithelial lesions: a ten-year experience. Dis Colon Rectum. 2008;51(6):829–35.

    Article  PubMed  Google Scholar 

  32. Singh JC, Kuohung V, Palefsky JM. Efficacy of trichloroacetic acid in the treatment of anal intraepithelial neoplasia in HIV-positive and HIV-negative men who have sex with men. J Acquir Immune Defic Syndr. 2009;52:474–9.

    PubMed  CAS  Google Scholar 

  33. Fox PA, Nathan M, Francis N, Singh N, Weir J, Dixon G, et al. A double-blind, randomized controlled trial of the use of imiquimod cream for the treatment of anal canal high-grade anal intraepithelial neoplasia in HIV-positive MSM on HAART, with long-term follow-up data including the use of open-label imiquimod. AIDS. 2010;24:2331–5.

    Article  PubMed  CAS  Google Scholar 

  34. Park IU, Palefsky JM. Evaluation and management of anal intraepithelial neoplasia in HIV-negative and HIV-positive men who have sex with men. Curr Infect Dis Rep. 2010;12:126–33.

    Article  PubMed  Google Scholar 

  35. Nathan M, Hickey N, Mayuranathan L, Vowler SL, Singh N. Treatment of anal human papillomavirus-associated disease: a long term outcome study. Int J STD AIDS. 2008;19:445–9.

    Article  PubMed  CAS  Google Scholar 

  36. Pineda CE, Welton ML. Management of anal squamous intraepithelial lesions. Clin Colon Rectal Surg. 2009;22:94–101.

    Article  PubMed  Google Scholar 

  37. Abbas A, Yang G, Fakih M. Management of anal cancer in 2010. Part 2: current treatment standards and future directions. Oncology. 2010;24:417–24 (Williston Park).

    PubMed  Google Scholar 

  38. Oehler-Janne C, Huguet F, Provencher S, Seifert B, Negretti L, Riener MO, et al. HIV-specific differences in outcome of squamous cell carcinoma of the anal canal: a multicentric cohort study of HIV-positive patients receiving highly active antiretroviral therapy. J Clin Oncol. 2008;26:2550–7.

    Article  PubMed  Google Scholar 

  39. Chiao EY, Giordano TP, Richardson P, El-Serag HB. Human immunodeficiency virus-associated squamous cell cancer of the anus: epidemiology and outcomes in the highly active antiretroviral therapy era. J Clin Oncol. 2008;26:474–9.

    Article  PubMed  Google Scholar 

  40. Hammad N, Heilbrun LK, Gupta S, Tageja N, Philip PA, Shields AF, et al. Squamous cell cancer of the anal canal in HIV-infected patients receiving highly active antiretroviral therapy: a single institution experience. Am J Clin Oncol. 2011;34:135–9.

    PubMed  CAS  Google Scholar 

  41. Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis. 2002;29:725–35.

    Article  PubMed  Google Scholar 

  42. Castellsague X, Bosch FX, Munoz N, Meijer CJ, Shah KV, de Sanjose S, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002;346:1105–12.

    Article  PubMed  Google Scholar 

  43. •• Palefsky JM, Giuliano AR, Goldstone S, Moreira ED, Jr., Aranda C, Jessen H et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med. 2011;365:1576–85. This landmark study demonstrates a significant reduction in the development of AIN in MSM given HPV vaccine.

  44. Kreimer AR, Gonzalez P, Katki HA, Porras C, Schiffman M, Rodriguez AC, et al. Efficacy of a bivalent HPV 16/18 vaccine against anal HPV 16/18 infection among young women: a nested analysis within the Costa Rica Vaccine Trial. Lancet Oncol. 2011;12:862–70.

    Article  PubMed  CAS  Google Scholar 

  45. http://www.cdc.gov/media/releases/2011/t1025_hpv_12yroldvaccine.html. Last accessed 11/17/2011

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Correspondence to Lawrence Crane.

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Mitra, S., Crane, L. Diagnosis, Treatment, and Prevention of Anal Cancer. Curr Infect Dis Rep 14, 61–66 (2012). https://doi.org/10.1007/s11908-011-0227-3

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