Incidence, Mortality and Survival Patterns of Anal Cancer in the United States, 1975-2007: Results from the Surveillance, Epidemiology and End Results Program Público

Abstract

Abstract

Background: Anal cancer is a rare malignancy of the anogenital tract. According to
the American Cancer Society, there were approximately 5,260 new cases and 720 deaths from
anal cancer in the United States in 2010. Studies have indicated that up to 93% of anal cancers
are associated with the most common risk factor, HPV infection. Higher risk groups include
persons with HIV-related immunosuppression, in particular men who have sex with men (MSM).
The purpose of this descriptive epidemiology study was to investigate patterns of anal cancer
incidence, mortality and survival in the United States between January 1, 1975 and December
31, 2007.
Methods: These publicly available data were obtained from the Surveillance, Epidemiology, and
End Results (SEER) Program, a system of population-based tumor registries in the United States.
SEER*Stat was used to generate age-adjusted incidence and mortality rates, age-specific
incidence rates, and 5-year relative survival of anal cancer according to year of diagnosis, age
group, sex, and race. Distributions of tumor histologic type and tumor stage were also generated.
Results: Incidence rates were generally higher among women than men (1.6 per 100,000 person-
years and 1.3 per 100,000 person-years, respectively, during 2000-2007, the most recent period
for which data were available). However, the incidence rates appeared to increase more rapidly
among males. Mortality rates increased at the beginning of the study period for all groups
regardless of race, sex, or year of diagnosis, but leveled off in recent years (approximately 0.02
per 100,000 person-years during 2000-2007). African Americans had similar incidence and
mortality rates when compared to whites but their 5-year relative survival was lower (54.8% and
65.3 respectively). Squamous Cell Carcinoma (SCC) accounted for an increasing proportion of
anal cancer cases in recent years, 47.2% from 1975-1984 and 70.1% from 1995-2007.
Conclusions: The incidence of anal cancer in the United States increased between 1975 and 2007
for both males and females, with males having a more pronounced increase. African Americans
had similar incidence and mortality rates when compared to whites but their relative survival was
lower. SCC became more common over the course of the study period.

Table of Contents

TABLE OF CONTENTS

INTRODUCTION 8

BACKGROUND 9

Anatomy 9

Occurrence 9

Risk Factors 10

Prevention 14

Diagnosis and Treatment 15

THESIS RATIONALE AND OBJECTIVE 16

METHODS 17

Data Source 17

Study Variables 18

Data Analysis 20

RESULTS 21

Incidence and Mortality 21

Histology and Stage 23

Survival 24

DISCUSSION 24

Incidence Rates 24

Mortality Rates 25

Stage and Histologic Type 26

Survival 26

Strengths and Limitations 27

Future research 28

CONCLUSION 28

REFERENCES 30

LIST OF ABBREVIATIONS 33

TABLES 34

FIGURES 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	SEER anal cancer
Committee Chair / Thesis Advisor	Mink, Pamela, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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