D. R. Bezzini1, G. Ortega2, N. Branch2, N. Changoor2, M. Sabtala1, D. H. Ford1,2 1Howard University College Of Medicine,Washington, DC, USA 2Howard University Hospital,Department Of Surgery,Washington, DC, USA
Introduction:
Anal cancer affects an estimated 7,200 patients nationally each year. Current literature suggests women make up 60% of all cases, but rates of diagnosis in males have increased nearly twice as fast as that of affected females. The aim of this study was to elucidate differences in demographics and outcomes of African Americans diagnosed with anal cancer at an urban institution in a city with high HIV infection rates.
Methods:
The study used a retrospective chart review of the institution’s cancer registry data from 1994 to 2014. Information was collected on gender, race, ethnicity, age of diagnosis, comorbidities including HIV status, primary lesion site, surgery type, pathology, histology, surgical margins, staging, radiation therapy status, chemotherapy status, and mortality. Descriptive statistics and multivariate analysis were adjusted for age, gender, race, morbidity, staging, radiation, and surgery. The primary outcome of interest was patient mortality.
Results:
There were 63 patients that met inclusion criteria. Of those patients, 64% were male (n=40), 92% were black (n=58), and the mean age of diagnosis was 53 years of age, with men diagnosed earlier at 49.5 years of age and women later at 59.5 years of age. A total of 21% were HIV positive (n=13), with 8.7% of females (n=2) and 27.5% of males (n=11) affected. The most common histologic finding was squamous cell carcinoma at 48% (n=30), affecting 30% of females (n=7) and 57% of males (n=23). The most common American Joint Committee on Cancer stage was stage two anal cancer for 21% of women (n=5) and 25% of men (n=10). In terms of surgical intervention, 13% of the population underwent abdominoperineal resection (n= 8), made up of 17% of females (n=4) and 10% of males (n=10). Chemotherapy and Radiation therapy rates showed 60% of men receiving each treatment (n=24). Chemotherapy was given to 47% (n=11) of women and radiation therapy to 56% of women (n=13). Of the sample, 52% of males (n=21) and females (n=12) were deceased. On adjusted analysis, for each year after 53 years of age, there was a 12% more likelihood of mortality (OR 1.12, CI: 1.02-1.24).
Conclusion:
Current statistics suggest that anal cancer rates have a higher occurrence in females than males. However, analysis of the cancer registry points to a higher occurrence in men. There was no mortality difference based on radiation, chemotherapy, or surgery status. In addition, the age of diagnosis among African Americans was about eight years sooner than the national mean. This shift may suggest that African Americans are diagnosed at a younger age. Based on these findings, urban hospitals should spread awareness of anal cancer risk within their population and advise screening for male patients. More data collection from a larger sampling of cases is needed to understand the extent of possible shifts in the population at risk of developing anal cancer.