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. 2023 Feb 1;152(3):417-428.
doi: 10.1002/ijc.34269. Epub 2022 Sep 16.

Global burden of HPV-attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis

Ashish A Deshmukh  1 , Haluk Damgacioglu  1 , Damien Georges  2 , Kalyani Sonawane  1 , Jacques Ferlay  3 , Freddie Bray  3 , Gary M Clifford  2
Affiliations

Global burden of HPV-attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis

Ashish A Deshmukh et al. Int J Cancer. .

Abstract

Squamous cell carcinoma of the anus (SCCA) is caused by HPV, and is elevated in persons living with HIV (PLWHIV). We aimed to estimate sex- and HIV-stratified SCCA burden at a country, regional and global level. Using anal cancer incidence estimates from 185 countries available through GLOBOCAN 2020, and region/country-specific proportions of SCCA vs non-SCCA from the Cancer Incidence in Five Continents (CI5) Volume XI database, we estimated country- and sex-specific SCCA incidence. Proportions of SCCA diagnosed in PLWHIV, and attributable to HIV, were calculated using estimates of HIV prevalence (UNAIDS 2019) and relative risk applied to SCCA incidence. Of 30 416 SCCA estimated globally in 2020, two-thirds occurred in women (19 792) and one-third among men (10 624). Fifty-three percent of male SCCA and 65% of female SCCA occurred in countries with a very high Human Development Index (HDI). Twenty-one percent of the global male SCCA burden occurred in PLWHIV (n = 2203), largely concentrated in North America, Europe and Africa. While, only 3% of global female SCCA burden (n = 561) occurred in PLWHIV, mainly in Africa. The global age-standardized incidence rate of HIV-negative SCCA was higher in women (0.55 cases per 100 000) than men (0.28), whereas HIV-positive SCCA was higher in men (0.07) than women (0.02). HIV prevalence reached >40% in 22 countries for male SCCA and in 10 countries for female SCCA, mostly in Africa. Understanding global SCCA burden by HIV status can inform SCCA prevention programs (through HPV vaccination, screening and HIV control) and help raise awareness to combat the disease.

Keywords: HIV; anal cancer; global burden; human papillomavirus; squamous cell carcinoma of the anus.

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Conflict of interest statement

CONFLICT OF INTEREST

Dr Sonawane reported personal fees from Value Analytics Lab outside the submitted work. Dr Deshmukh reported consulting fees from Merck outside the submitted work. No other disclosures were reported.

Figures

FIGURE 1
FIGURE 1
Geographic distribution of world age-standardized incidence (per 100 000) of squamous cell carcinoma of the anus among men (A) and women (B), aged 15 years or older. ASIR, age-standardized incidence rate; NA, not available. The designations used and the presentation of the material in this Article do not imply the expression of any opinion whatsoever on the part WHO and the IARC about the legal status of any country, territory, city, or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries
FIGURE 2
FIGURE 2
Estimated proportions of new squamous cell carcinoma of the anus in persons living with HIV in 2020, worldwide and by United Nations region and sub-region. HIV, human immunodeficiency virus; SCCA, squamous cell carcinoma of the anus
FIGURE 3
FIGURE 3
Geographic distribution of worldwide estimation of proportion of squamous cell carcinoma of the anus in patients living with HIV in 2020. Proportions of SCCA in persons living with HIV for men (A) and for women (B). NA, not available. The designations used and the presentation of the material in this Article do not imply the expression of any opinion whatsoever on the part WHO and the IARC about the legal status of any country, territory, city, or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries
FIGURE 4
FIGURE 4
Age-standardized incidence (per 100 000) of squamous cell carcinoma of the anus with and without HIV in 2020, worldwide and by United Nations region and sub-region. ASIR, age-standardized incidence rate; SCCA, squamous cell carcinoma of the anus
FIGURE 5
FIGURE 5
Age-standardized incidence (per 100 000) of squamous cell carcinoma of the anus with and without HIV in 2020 among men and women in countries with available registry data. Incidence rates are arranged in decreasing order of overall SCCA incidence among men and women. ASIR, age-standardized incidence rate; SCCA, squamous cell carcinoma of the anus
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