title: Risk of anal cancer in a cohort with human papillomavirus-related gynecologic neoplasm.
abstract: OBJECTIVE
  To assess the development of anal cancer in women diagnosed with a human papillomavirus-related cervical, vulvar, or vaginal neoplasm.
  
  
  METHODS
  Using data from National Cancer Institute's Surveillance, Epidemiology and End Results program from 1973 through 2007, 189,206 cases with either in situ or invasive cervical, vulvar, or vaginal neoplasm were followed for 138,553,519 person-years for the development of subsequent primary anal cancer. Standardized incidence ratios were calculated from the observed number of subsequent anal cancers compared with those expected based on age-, race-, and calendar year-specific rates in the nonaffected population.
  
  
  RESULTS
  Anal cancer developed in 255 women with a history of in situ or invasive gynecologic neoplasm, aggregate standardized incidence ratio of 13.6 (95% confidence interval [CI] 11.9-15.3), indicating a 13-fold increase in anal cancer compared with expected. The standardized incidence ratio for anal cancer incidence among women with in situ vulvar cancer was 22.2 (95% CI 16.7-28.4) and was 17.4 (95% CI 11.5-24.4) for those with invasive vulvar cancer. The standardized incidence ratio for anal cancer incidence in women with in situ cervical cancer was 16.4 (95% CI 13.7-19.2) and was 6.2 (95% CI 4.1-8.7) for women with invasive cervical cancer. The standardized incidence ratio for anal cancer incidence among women with in situ vaginal cancer was 7.6 (95% CI 2.4-15.6) and was 1.8 (95% CI 0.2-5.3) for invasive vaginal cancer.
  
  
  CONCLUSIONS
  Women with human papillomavirus-related gynecologic neoplasm are at higher risk for developing anal cancer compared with the general population. This high-risk population may benefit from close observation and screening for anal cancer.
authors.affiliation: From Tufts Clinical and Translational Science Institute, Boston, Massachusetts; Lahey Clinic Medical Center, Burlington, Massachusetts; and St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Abdulaziz M
authors.initials: AM
authors.lastname: Saleem
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Paulus
authors.forename: Anne P
authors.initials: AP
authors.lastname: Shapter
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Roberts
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000821:virology; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology* / Q000532:radiotherapy / Q000821:virology; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000821:virology; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology* / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D018426:SEER Program; D055815:Young Adult