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Review
. 2023 Jun 22;12(13):4216.
doi: 10.3390/jcm12134216.

Anal Cancer and Anal Intraepithelial Neoplasia Risk among Patients Treated for HPV-Related Gynecological Diseases-A Systematic Review

Michał Brzeziński  1   2 , Maciej Stukan  1   2
Affiliations
Review

Anal Cancer and Anal Intraepithelial Neoplasia Risk among Patients Treated for HPV-Related Gynecological Diseases-A Systematic Review

Michał Brzeziński et al. J Clin Med. .

Abstract

Background: The most important causative agent of neoplasms in the anogenital area is the human papillomavirus (HPV). Due to the anatomical proximity of the genital and anus area and the ease with which HPV infection is transmitted, it seems that patients after the treatment of HPV-related gynecological diseases may have an increased risk of developing a second HPV-related neoplasm anal cancer. The aim of this study was to determine the risk of anal intraepithelial neoplasia (AIN) and anal cancer (AC) among patients after the treatment of HPV-related gynecological diseases.

Methods: We conducted a comprehensive review of the available literature from multiple databases. The study was performed following Cochrane Reviewers' Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. Moreover, we assessed the quality of each study using QUADAS-2.

Results: Twenty-five studies were included in the final analysis. Patients after the treatment of HPV-related gynecological diseases have a significantly higher risk of AC (mean standardized incidence ratio (SIR) = 5.387, mean incidence risk (IR) = 0.096%, mean IR per 100,000 person-years = 10.37) and AIN (mean IR = 23.683%) compared to the population risk.

Conclusions: patients with HPV-related gynecological diseases should constitute a group for which an appropriate primary and secondary screening for AC should be introduced.

Keywords: HPV; anal cancer; anal intraepithelial neoplasia; cancer; cervix; gynecology; human papillomavirus; intraepithelial neoplasia; vagina; vulva.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart summarizing the process for the identification of eligible articles. AC—anal cancer; AIN—anal intraepithelial neoplasia.
Figure 2
Figure 2
Anal mucosa seen with high-resolution anoscopy (HRA). Whitening of the anal mucosa after application of acetic acid indicates the probable location of anal intraepithelial neoplasia.
Figure 3
Figure 3
Surgical treatment of HSIL (AIN3) in perianal region. (a) Anal region with AIN before surgery. (b) Anal region after excision of AIN. (c,d) Anal region after reconstruction requiring skin grafts (Limberg flap). AIN—anal intraepithelial neoplasia.
See this image and copyright information in PMC

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