http://content.nejm.org/cgi/content/abstract/337/19/1350

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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.
Source Information

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.)

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.

Full Text of this Article

This article has been cited by other articles:

• Ferris, D. G., Waller, J. L., Miller, J., Patel, P., Price, G. A., Jackson, L., Wilson, C. (2009). Variables Associated With Human Papillomavirus (HPV) Vaccine Acceptance by Men. J Am Board Fam Med 22: 34-42 [Abstract] [Full Text]  
• Batty, H. P. (2008). What about the boys?. cfp 54: 1375-1375 [Full Text]  
• Madsen, B. S., van den Brule, A. J.C., Jensen, H. L., Wohlfahrt, J., Frisch, M. (2008). Risk Factors for Squamous Cell Carcinoma of the Penis--Population-Based Case-Control Study in Denmark. Cancer Epidemiol. Biomarkers Prev. 17: 2683-2691 [Abstract] [Full Text]  
• Uronis, H. E., Bendell, J. C. (2007). Anal Cancer: An Overview. The Oncologist 12: 524-534 [Abstract] [Full Text]  
• Nordenvall, C, Nyren, O, Ye, W (2006). Elevated anal squamous cell carcinoma risk associated with benign inflammatory anal lesions. Gut 55: 703-707 [Abstract] [Full Text]  
• Bodaghi, S., Wood, L. V., Roby, G., Ryder, C., Steinberg, S. M., Zheng, Z.-M. (2005). Could Human Papillomaviruses Be Spread through Blood?. J. Clin. Microbiol. 43: 5428-5434 [Abstract] [Full Text]  
• Bodaghi, S., Yamanegi, K., Xiao, S.-Y., Da Costa, M., Palefsky, J. M., Zheng, Z.-M. (2005). Colorectal Papillomavirus Infection in Patients with Colorectal Cancer. Clin. Cancer Res. 11: 2862-2867 [Abstract] [Full Text]  
• Ponz de Leon, M, Benatti, P, Borghi, F, Pedroni, M, Scarselli, A, Di Gregorio, C, Losi, L, Viel, A, Genuardi, M, Abbati, G, Rossi, G, Menigatti, M, Lamberti, I, Ponti, G, Roncucci, L (2004). Aetiology of colorectal cancer and relevance of monogenic inheritance. Gut 53: 115-122 [Abstract] [Full Text]  
• Hemminki, K., Li, X. (2003). Lifestyle and Cancer: Effect of Widowhood and Divorce. Cancer Epidemiol. Biomarkers Prev. 12: 899-904 [Abstract] [Full Text]  
• Frisch, M., Smith, E., Grulich, A., Johansen, C. (2003). Cancer in a Population-based Cohort of Men and Women in Registered Homosexual Partnerships. Am J Epidemiol 157: 966-972 [Abstract] [Full Text]  
• Walker, F., Kermorgant, S., Darai, E., Madelenat, P., Cremieux, A. C., Henin, D., Lehy, T. (2003). Hepatocyte Growth Factor and c-Met in Cervical Intraepithelial Neoplasia: Overexpression of Proteins Associated with Oncogenic Human Papillomavirus and Human Immunodeficiency Virus. Clin. Cancer Res. 9: 273-284 [Abstract] [Full Text]  
• Sobhani, I., Walker, F., Aparicio, T., Abramowitz, L., Henin, D., Cremieux, A. C., Soule, J. C. (2002). Effect of Anal Epidermoid Cancer-related Viruses on the Dendritic (Langerhans') Cells of the Human Anal Mucosa. Clin. Cancer Res. 8: 2862-2869 [Abstract] [Full Text]  
• Esiashvili, N., Landry, J., Matthews, R. H. (2002). Carcinoma of the Anus: Strategies in Management. The Oncologist 7: 188-199 [Abstract] [Full Text]  
• Schecter, W. P. (2001). Human Immunodeficiency Virus and Malignancy: Thoughts on Viral Oncogenesis. Arch Surg 136: 1419-1425 [Full Text]  
• Carter, J. J., Madeleine, M. M., Shera, K., Schwartz, S. M., Cushing-Haugen, K. L., Wipf, G. C., Porter, P., Daling, J. R., McDougall, J. K., Galloway, D. A. (2001). Human Papillomavirus 16 and 18 L1 Serology Compared across Anogenital Cancer Sites. Cancer Res. 61: 1934-1940 [Abstract] [Full Text]  
• Ryan, D. P., Compton, C. C., Mayer, R. J. (2000). Carcinoma of the Anal Canal. NEJM 342: 792-800 [Full Text]  
• Frisch, M., Glimelius, B., Wohlfahrt, J., Adami, H.-O., Melbye, M. (1999). Tobacco Smoking as a Risk Factor in Anal Carcinoma: an Antiestrogenic Mechanism?. JNCI J Natl Cancer Inst 91: 708-715 [Abstract] [Full Text]  
• Moscicki, A.-B., Hills, N. K., Shiboski, S., Darragh, T. M., Jay, N., Powell, K., Hanson, E., Miller, S. B., Farhat, S., Palefsky, J. (1999). Risk Factors for Abnormal Anal Cytology in Young Heterosexual Women. Cancer Epidemiol. Biomarkers Prev. 8: 173-178 [Abstract] [Full Text]  
• Frisch, M., Fenger, C., van den Brule, A. J. C., Sorensen, P., Meijer, C. J. L. M., Walboomers, J. M. M., Adami, H.-O., Melbye, M., Glimelius, B. (1999). Variants of Squamous Cell Carcinoma of the Anal Canal and Perianal Skin and Their Relation to Human Papillomaviruses. Cancer Res. 59: 753-757 [Abstract] [Full Text]  
• Vernon, S. D., Unger, E. R., Reeves, W. C., Frisch, M., Adami, H.-O., Melbye, M., Ellerbrock, T. V., Kuhn, L., Wright, T. C. (1998). Human Papillomaviruses and Anogenital Cancer. NEJM 338: 921-922 [Full Text]  
• (1998). Anal Carcinoma Is an STD. Journal Watch Dermatology 1998: 11-11 [Full Text]  
• Shah, K. V. (1997). Human Papillomaviruses and Anogenital Cancers. NEJM 337: 1386-1388 [Full Text]