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Previous Volume 337:1350-1358 November 6, 1997 Number 19 Next

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ABSTRACT

Background The incidence of anal cancer has increased in recent decades, particularly among women. To identify underlying risk factors, we conducted a population-based case–control study in Denmark and Sweden.

Methods We conducted telephone interviews with 324 women and 93 men in whom invasive or in situ anal cancer was diagnosed between 1991 and 1994, 534 controls with adenocarcinoma of the rectum, and 554 population controls. The interviews covered a wide spectrum of possible risk factors for anal cancer. Odds ratios were calculated by logistic regression. Specimens of anal-cancer tissue and samples of rectal adenocarcinomas were tested for human papillomavirus (HPV) DNA with the polymerase chain reaction.

Results Multivariate analysis revealed consistent and statistically significant associations between measures of sexual promiscuity and the risk of anal cancer in both men and women. There was a significant trend toward an association between higher numbers of partners of the opposite sex in women (P<0.001) and men (P<0.05) and strong associations with a variety of venereal diseases. In women, receptive anal intercourse, particularly before the age of 30 years, and venereal infections in the partner were also associated with an increased risk (odds ratios, 3.4 and 2.4, respectively). Fifteen percent of the men with anal cancer reported having had homosexual contact, as compared with none of the controls (P<0.001). High-risk types of HPV, notably HPV-16, were detected in 84 percent of the anal-cancer specimens examined, whereas all rectal-adenocarcinoma specimens tested were negative for HPV.

Conclusions Our study provides strong evidence that a sexually transmitted infection causes anal cancer. The presence of high-risk types of HPV, notably HPV-16 (which is known to cause cancer of the cervix), in the majority of anal-cancer tissue specimens suggests that most anal cancers are potentially preventable. (N Engl J Med 1997;337;1350-8.)

Source Information

From the Department of Epidemiology Research, Danish Epidemiology Science Center, Statens Serum Institut, Copenhagen, Denmark (M.F., J.W., M.M.); the Department of Oncology, University Hospital, Uppsala, Sweden (B.G.); the Department of Pathology, Section for Molecular Pathology, University Hospital, Vrije Universiteit, Amsterdam (A.J.C.B., C.J.L.M.M., J.M.M.W.); the Department of Surgery, Ersta Hospital, Stockholm, Sweden (S.G.); the Oncology Department of Southern Stockholm, Huddinge University Hospital, Stockholm, Sweden (C.S.); the Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden (H.-O.A.); and the Department of Epidemiology and Harvard Center for Cancer Prevention, Harvard University, Boston (H.-O.A.).

Address reprint requests to Dr. Frisch at the Department of Epidemiology Research, Danish Epidemiology Science Center, Statens Serum Institut, 2300-Copenhagen S, Denmark.

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