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Review
. 2022 Dec 22;15(1):60.
doi: 10.3390/cancers15010060.

Anal Cancer in High-Risk Women: The Lost Tribe

Micol Lupi  1   2 , Danielle Brogden  2 , Ann-Marie Howell  2 , Paris Tekkis  1   2 , Sarah Mills  1   2 , Christos Kontovounisios  1   2
Affiliations
Review

Anal Cancer in High-Risk Women: The Lost Tribe

Micol Lupi et al. Cancers (Basel). .

Abstract

In developed countries the incidence of anal squamous cell carcinoma (SCC) has been rising; especially in women over the age of 60 years who present with more advanced disease stage than men. Historically, anal SCC screening has focused on people living with Human Immunodeficiency Virus (HIV) (PLWH) who are considered to be at the highest risk of anal SCC, and its precancerous lesion, anal squamous intraepithelial lesion (SIL). Despite this, women with vulval high-grade squamous epithelial lesions (HSIL) and SCCs have been shown to be as affected by anal HSIL and SCC as some PLWH. Nevertheless, there are no guidelines for the management of anal HSIL in this patient group. The ANCHOR trial demonstrated that treating anal HSIL significantly reduces the risk of anal SCC in PLWH, there is therefore an unmet requirement to clarify whether the screening and treatment of HSIL in women with a prior genital HSIL is also beneficial. This review presents the current evidence supporting the screening, treatment, and surveillance of anal HSIL in high-risk women with a previous history of genital HSIL and/or SCC.

Keywords: HPV; HSIL; SCC; anal; genital; women.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CyclinD/cdk4/6 complex phosphorylate pRB causing it to release E2F and allow progression of the cell cycle past the G1/S Restriction Point. Oncoprotein E7 acts by inhibiting pRb. Among other functions p53 activates p21, a cdk inhibitor regulating the G1/S checkpoint. Oncoprotein E6 promotes the degradation of p53.
Figure 2
Figure 2
Hypothetical anal cancer screening model for the early detection and treatment of anal HSIL.
Figure 3
Figure 3
WHO screening criteria. Key: Green = good evidence, Orange = moderate/circumstantial evidence.
See this image and copyright information in PMC

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