Saturday , October 31 2020

Anal cancer and deaths are rising in the United States

Researchers examined trends in anal cancer over the past 15 years and identified approximately 69,000 anal cancer cases and over 12,000 deaths during this time.

"Our findings regarding the dramatic increase in morbidity among black millennia and white women, the growing proportion of distant diseases and the increase in mortality from anal cancer are very worrying," study lead author Ashish A. Deshmukh, assistant professor at UTHealth School of Public Health, said in a statement . "Given the historical belief that anal cancer is rare, it is often neglected."

Distant disease occurs when the cancer has spread to other parts of the body.

In the years 2001–2015 the number of cases of the most common anal cancer increased by 2.7% per year, while the number of deaths due to anal cancer increased by 3.1% per year in the years 2001–2016.

The study, published in the Journal of the National Cancer Institute, "gives trend trends that seems to have occurred over the past decade," said Dr. Virginia Shaffer, colon surgeon and associate professor at Winship Cancer Institute Emory University. "In this sense, it gives us what we already expected." Shaffer was not involved in the study.

HPV-related cancer

Anal cancer occurs where the gastrointestinal tract ends. It differs from colon or rectal cancer and is 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 anal cancer cases are associated with HPV, according to US disease control and prevention centers.
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Some high-risk groups have implemented anal cancer screening, but the authors say their results suggest 'wider screening should be considered'. However, they are convinced that the increase in diagnosis is probably not due to an increase in screening practices.
Since the 1950s, there have been significant changes in anal cancer risk factors, including changes in sexual behavior and an increased number of sexual partners, according to a study that increase the likelihood of contracting HPV.
The emergence of the HIV epidemic, especially among men having sex with men, could also have an effect on anal cancer trends because HIV is a risk factor.
There are also other risk factors such as cervical or vulva cancer, organ transplant or being a smoker.

Who is affected by anal cancer?

The study showed that anal cancer has increased significantly in people 50 years of age and older.

Perhaps because the guidelines for the HPV vaccine are "very narrow," said Shaffer, limiting the protection of older people. 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 already far from this border when the vaccine appeared," Shaffer said. "It's a large number of people who haven't received the vaccine."
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Anal cancer rates are also rising among young black men.

The study found that HIV disproportionately affects young black men, and having HIV is a risk factor for anal cancer.

The study also showed that the number of cases in advanced stages is increasing. This may partly be due to an improvement in HIV treatment, said Shaffer, which means that patients live longer with a weakened immune system, and the cancer may have developed until it is diagnosed.

Stigma retention

There is still a stigma around anal cancer.

As she said, "Desperate Housewives" star Marcia Cross opened her diagnosis of anal cancer earlier this year to help digitize the disease.

"I know there are people who are ashamed," Cross said in June, "CBS This Morning." "You have cancer. You should also feel like then are you ashamed if you did something wrong because he lived in your anus? "

Anal cancer has become a "pretty taboo" – said Shaffer – "I think because of some risk factors that are known to be associated with it.

"If people have symptoms, they should see a doctor because I think a lot of people think," Oh, well, it's just hemorrhoids, "and they don't control, and that could potentially mean you won't be diagnosed until much, much later ".

Anal cancer can be prevented by vaccination against HPV. The CDC recommends two doses of the vaccine every year in the US for children between 11 and 12 years of age. You can also vaccinate young adults up to 26 years old. Elderly adults should talk to their doctor because the vaccine is most beneficial when given at a young age before the person is exposed to HPV.

To strengthen future prevention, Shaffer said that all people who qualify for vaccination should do so, and that current vaccine guidelines should be studied to determine if they can be extended to other patients.

Michael Nedelman, Lisa Respers France and Sandee LaMotte from CNN contributed to this report.

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