NEW YORK (Reuters Health) Mar 01 - Gynecologic neoplasms due to human papilloma virus (HPV) can significantly increase a woman's risk of anal cancer, according to a report in the March issue of Obstetrics & Gynecology.
For example, the risk of anal cancer was 17-fold higher for women with vulvar cancer and 16-fold higher with in situ cervical cancer.
Dr. Rocco Ricciardi from Tufts University Medical School, Burlington, Massachusetts, and colleagues used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry to measure the incidence of secondary anal cancers in 189,206 women diagnosed with gynecologic cancers between 1973 and 2007.
There were 255 cases of anal cancer during close to 139 million person-years of follow-up, including 58 cases among 56,876 women with invasive primary gynecologic neoplasm and 197 cases among 132,330 women with in situ gynecologic neoplasm.
The standard incidence ratios for anal cancer were 6.2, 17.4, and 1.8 for women with invasive cervical, vulvar, and vaginal cancer, respectively, and even higher for women with in situ cervical, vulvar, and vaginal cancer: 16.4, 22.2, and 7.6, respectively.
Results were similar when the authors used a restrictive analysis method that removed the potential of confounding from other cancer treatment.
The mean interval between the primary gynecologic malignancy and the primary anal cancer ranged from 7.1 years for invasive vulvar neoplasm to 15.7 years for in situ cervical neoplasm.
The risk of anal cancer among women with a previous cervical cancer was similar whether or not they received radiotherapy for their primary cancer, whereas the data were inconclusive for vulvar and vaginal cancer.
"These data indicate that women with both in situ and invasive cancers of the cervix and vulva are at higher risk for developing anal cancer than the general population and may benefit from close observation and anal cancer screening," the researchers conclude.
As for surveillance, Dr. Ricciardi said, "There are no definitive guidelines to date. More data are needed that demonstrate a health benefit to screening before guidelines can be developed."
"Further studies are needed to identify the highest risk patients," Dr. Ricciardi said. "Some of these women may benefit solely from a simple rectal exam. A comparison of anal Pap smear versus simple rectal exam would be a good first step."
"According to our data, those treated with irradiation are not protected from the development of incident anal cancer and should still be considered high risk," the investigators said.
Obstet Gynecol. 2011;117:643-649. Abstract
For example, the risk of anal cancer was 17-fold higher for women with vulvar cancer and 16-fold higher with in situ cervical cancer.
Dr. Rocco Ricciardi from Tufts University Medical School, Burlington, Massachusetts, and colleagues used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry to measure the incidence of secondary anal cancers in 189,206 women diagnosed with gynecologic cancers between 1973 and 2007.
There were 255 cases of anal cancer during close to 139 million person-years of follow-up, including 58 cases among 56,876 women with invasive primary gynecologic neoplasm and 197 cases among 132,330 women with in situ gynecologic neoplasm.
The standard incidence ratios for anal cancer were 6.2, 17.4, and 1.8 for women with invasive cervical, vulvar, and vaginal cancer, respectively, and even higher for women with in situ cervical, vulvar, and vaginal cancer: 16.4, 22.2, and 7.6, respectively.
Results were similar when the authors used a restrictive analysis method that removed the potential of confounding from other cancer treatment.
The mean interval between the primary gynecologic malignancy and the primary anal cancer ranged from 7.1 years for invasive vulvar neoplasm to 15.7 years for in situ cervical neoplasm.
The risk of anal cancer among women with a previous cervical cancer was similar whether or not they received radiotherapy for their primary cancer, whereas the data were inconclusive for vulvar and vaginal cancer.
"These data indicate that women with both in situ and invasive cancers of the cervix and vulva are at higher risk for developing anal cancer than the general population and may benefit from close observation and anal cancer screening," the researchers conclude.
As for surveillance, Dr. Ricciardi said, "There are no definitive guidelines to date. More data are needed that demonstrate a health benefit to screening before guidelines can be developed."
"Further studies are needed to identify the highest risk patients," Dr. Ricciardi said. "Some of these women may benefit solely from a simple rectal exam. A comparison of anal Pap smear versus simple rectal exam would be a good first step."
"According to our data, those treated with irradiation are not protected from the development of incident anal cancer and should still be considered high risk," the investigators said.
Obstet Gynecol. 2011;117:643-649. Abstract
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