M. M. Bojko1, R. Kucejko1, J. L. Poggio1 1Drexel University College Of Medicine,Colorectal Surgery/Surgery,Philadelphia, Pa, USA 2Drexel University College Of Medicine,Philadelphia, Pa, USA
Introduction:
Recent studies have identified an increased incidence of squamous cell carcinoma of the anus (SCCA) in the young male population. This may be attributed to changing sexual practices leading to increased susceptibility to infection with Human Papillomavirus. Prior studies have identified black race as contributing to higher incidence, but they were limited by region and did not specifically address age or socioeconomic status. We aim to identify populations at risk so screening programs and community outreach may be appropriately directed to best affect the rising public health burden.
Methods:
The National Cancer Institute’s Surveillance of Epidemiology and End Results database was queried for data on patients with SCCA for the years of 2000-2013. Cases were selected by ICD-0-3 site codes corresponding to the anus, and only cases identified histologically as SCCA were included. SEER*Stat version 8.3.2 and SPSS version 24.0.0.0 were used to calculate incidence and survival using cox-regression analysis. Age, sex, race, and socioeconomic status were evaluated for their effect. Significance was calculated at the 95% confidence interval, and all P-values were 0.05 or below.
Results:
16,908 cases were identified with SCCA. Overall, the incidence rate of SCCA was twice as high in black men compared to white men aged <35 years between 2000-2013 (p < 0.001). Cox regression analysis of male patients <49 identified black race to have a hazard ratio of 1.55 (CI 1.33 to 1.81) when compared to white race. It also identified a hazard ratio of 0.90 (CI 0.86 to 0.94) associated with each $10,000 increase in median family income. Among this sample, black men had an incidence rate of 2.7 and 2.8 times that for white men for regional and distant disease, respectively. Figure 1 illustrates the lower survival among black men compared to other races.
Conclusion:
In the male population less than 49 years old, the incidence of SCCA is significantly higher in black men compared to white men, and their disease is diagnosed at later stages. Higher median family income is an independent predictor of survival, and when adjusted for stage and median family income, black men have a significantly lower survival compared to white men. Treatment parameters are established for SCCA but there is no consensus on screening parameters. New screening programs have been developed in the recent years, and data suggest they have a positive impact on incidence and survival. Given these results and our own data, we encourage all physicians to identify high-risk individuals and proceed with screening for anal cancer. Furthermore, work is needed to develop health outreach programs to target populations at higher risk, such as the low-income, black male population.
