J Gastrointest Canc (2014) 45:234–238 DOI 10.1007/s12029-014-9607-x
BRIEF COMMUNICATION
Survival from Anal Cancer Among Hispanics—Puerto Rico, 2000–2007 Vivian Colon-Lopez & Ana P. Ortiz & Marievelisse Soto-Salgado & Mariela Torres-Cintrón & Naydi Perez & Juan José Mercado-Acosta & Humberto M. Guiot & Erick Suarez
Published online: 4 April 2014 # Springer Science+Business Media New York 2014
Abstract Purpose The incidence of anal cancer is increasing, particularly among HIV and men who have sex with men (MSM) groups. The vast majority of cases are associated with human papillomavirus (HPV), the most common sexually transmitted infection. Epidemiological studies have also documented low survival, which might be linked to lack of appropriate screening, access, and utilization of pertinent health care services. Our objective was to assess the relative survival (1 and 3 years) of anal cancer in Puerto Rico for men and women during the period from 2000–2007. Methods All histological types of cancer of anus, anal canal, and anorectum (ICD-O-3 codes C210-C218), except for sarcomas, were included. Relative survival was estimated with the use of life tables from the population of Puerto Rico. In addition, the excess survival was compared by age at diagnosis, histology, and stage (defined as local, regional, or distant), using the Poisson regression model. V. Colon-Lopez (*) : M. Torres-Cintrón Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico e-mail: [email protected] V. Colon-Lopez : A. P. Ortiz Department of Health Services Administration, University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, PO Box 36937, San Juan 00936, Puerto Rico A. P. Ortiz : E. Suarez Department of Biostatistics and Epidemiology, University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, San Juan, Puerto Rico M. Soto-Salgado UPR/MDACC Partnership in Excellence in Cancer Research Program, University of Puerto Rico, Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico
Results The overall 3-year relative survival in Puerto Rico was the same (53 %) for men and women. Conclusions Our findings establish baseline survival data for anal cancer in Hispanics from Puerto Rico. Since now, the national guidelines for anal cancer screening and treatment are on their way to be determined; baseline information about survival will allow monitoring the efficacy that standardized screening programs may eventually have in increasing anal cancer survival in this population. Keywords Anal cancer . Survival . Puerto Rico . Epidemiology
Introduction Reports indicate that oncogenic HPV genotypes are a key causal precursor for anal cancer [1] and its precursor lesion known as anal intraepithelial neoplasia (AIN). In the USA, the M. Soto-Salgado Doctoral Program in Public Health with Specialty in Social Determinants of Health, Department of Social Sciences, University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, San Juan, Puerto Rico M. Torres-Cintrón : N. Perez Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico J. J. Mercado-Acosta Department of Pathology, University of Puerto Rico, Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico H. M. Guiot Division of Infectious Diseases, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
J Gastrointest Canc (2014) 45:234–238
incidence rate for anal cancer has increased for both men and women during the past three decades [2], with a higher incidence rate among MSM, particularly HIV-positive MSM [3]. Several factors have been associated with anal cancer, including anal sex, smoking, receptive anal intercourse, and increased number of lifetime sexual partners [4–6]. In Puerto Rico (PR), a population-based study reported that 64.4 and 57.1 % of the men and women, respectively, had ever engaged in anal sex [4]. This is twice the estimated rate reported by the 2002–2003 National Survey for Family Growth in the USA among persons aged 15–44 years [5]. Furthermore, among MSM from PR, a population-based study reported that 22.6 % of this population indicated having receptive anal sex with a man within the past 12 months and more than 10 % of them acknowledged having more than five lifetime sex partners with whom they ever engaged in receptive anal sex [6]. These findings, combined with lack of data regarding the particularities of anal cancer among Hispanics [7], highlight the necessity to study the epidemiology of anal cancer in PR in order to develop targeted strategies to decrease the burden of this disease. Within the cancer continuum, along with morbidity and mortality, determining survival of anal cancer gives an opportunity to explore health disparities. Therefore, this study aimed to determine the relative 1- and 3-year survival after diagnosis of anal cancer for the period of 2000 to 2007 in PR.
Methods Inclusion Criteria To assess the relative survival of anal cancer in PR (1 and 3 years) for men and women, we analyzed the incidence and mortality information for anal cancer cases reported to the PR Central Cancer Registry (PRCCR) for the period of 2000– 2007. All histological types of cancer of the anus, anal canal, and anorectum (ICD-O-3 codes C210-C218), except for sarcoma, for the period of 2000–2007 were included. For the analyses focused on histologies, tumors were categorized by histological type according to the International Classification of Diseases for Oncology (ICD-O-3) as follows: squamous cell carcinoma (codes 8010 and 8051-8081), cloacogenic (including basaloid codes 8120-8124), and adenocarcinoma (codes 8140-8263 and 8480-8481). The survival analysis was limited only to patients who had a first primary anal tumor that was confirmed microscopically and had invasive disease. The follow-up period of patients was until the date of death or December 31, 2010 (whichever occurred first). Exclusion Criteria For the period of 2000 to 2007, 417 cases of anal cancer were reported to the PRCCR. Cases were excluded from the analysis
235
if the anal cancer was not the patient’s primary cancer, cases identified through autopsy, or death certificate only were also excluded. Also, as in other similar studies in the literature [7], cases without microscopic confirmation and tumors identified as in situ lesions were excluded. After these exclusions, 228 cases remained for the survival analysis. Statistical Analysis Relative survival was estimated with the use of life tables (stratified by age, sex, and calendar time) from the population of PR [8], as the ratio of the observed survival of the patients (where all deaths are considered events) to the expected survival, using the strs command in STATA/IC 12.0 [9]. In addition, the excess survival was compared by age at diagnosis, histology, and stage (defined as local, regional, or distant), using the Poisson regression model.
Results Descriptive statistics for anal cancer by age at diagnosis, stage, and histology are shown in Table 1. A higher proportion of anal cancer cases were observed in women, as compared with men. An inverse proportion in anal cancer cases by age group was observed by gender. A higher proportion of cases in men were in the
BRIEF COMMUNICATION
Survival from Anal Cancer Among Hispanics—Puerto Rico, 2000–2007 Vivian Colon-Lopez & Ana P. Ortiz & Marievelisse Soto-Salgado & Mariela Torres-Cintrón & Naydi Perez & Juan José Mercado-Acosta & Humberto M. Guiot & Erick Suarez
Published online: 4 April 2014 # Springer Science+Business Media New York 2014
Abstract Purpose The incidence of anal cancer is increasing, particularly among HIV and men who have sex with men (MSM) groups. The vast majority of cases are associated with human papillomavirus (HPV), the most common sexually transmitted infection. Epidemiological studies have also documented low survival, which might be linked to lack of appropriate screening, access, and utilization of pertinent health care services. Our objective was to assess the relative survival (1 and 3 years) of anal cancer in Puerto Rico for men and women during the period from 2000–2007. Methods All histological types of cancer of anus, anal canal, and anorectum (ICD-O-3 codes C210-C218), except for sarcomas, were included. Relative survival was estimated with the use of life tables from the population of Puerto Rico. In addition, the excess survival was compared by age at diagnosis, histology, and stage (defined as local, regional, or distant), using the Poisson regression model. V. Colon-Lopez (*) : M. Torres-Cintrón Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico e-mail: [email protected] V. Colon-Lopez : A. P. Ortiz Department of Health Services Administration, University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, PO Box 36937, San Juan 00936, Puerto Rico A. P. Ortiz : E. Suarez Department of Biostatistics and Epidemiology, University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, San Juan, Puerto Rico M. Soto-Salgado UPR/MDACC Partnership in Excellence in Cancer Research Program, University of Puerto Rico, Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico
Results The overall 3-year relative survival in Puerto Rico was the same (53 %) for men and women. Conclusions Our findings establish baseline survival data for anal cancer in Hispanics from Puerto Rico. Since now, the national guidelines for anal cancer screening and treatment are on their way to be determined; baseline information about survival will allow monitoring the efficacy that standardized screening programs may eventually have in increasing anal cancer survival in this population. Keywords Anal cancer . Survival . Puerto Rico . Epidemiology
Introduction Reports indicate that oncogenic HPV genotypes are a key causal precursor for anal cancer [1] and its precursor lesion known as anal intraepithelial neoplasia (AIN). In the USA, the M. Soto-Salgado Doctoral Program in Public Health with Specialty in Social Determinants of Health, Department of Social Sciences, University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, San Juan, Puerto Rico M. Torres-Cintrón : N. Perez Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico J. J. Mercado-Acosta Department of Pathology, University of Puerto Rico, Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico H. M. Guiot Division of Infectious Diseases, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
J Gastrointest Canc (2014) 45:234–238
incidence rate for anal cancer has increased for both men and women during the past three decades [2], with a higher incidence rate among MSM, particularly HIV-positive MSM [3]. Several factors have been associated with anal cancer, including anal sex, smoking, receptive anal intercourse, and increased number of lifetime sexual partners [4–6]. In Puerto Rico (PR), a population-based study reported that 64.4 and 57.1 % of the men and women, respectively, had ever engaged in anal sex [4]. This is twice the estimated rate reported by the 2002–2003 National Survey for Family Growth in the USA among persons aged 15–44 years [5]. Furthermore, among MSM from PR, a population-based study reported that 22.6 % of this population indicated having receptive anal sex with a man within the past 12 months and more than 10 % of them acknowledged having more than five lifetime sex partners with whom they ever engaged in receptive anal sex [6]. These findings, combined with lack of data regarding the particularities of anal cancer among Hispanics [7], highlight the necessity to study the epidemiology of anal cancer in PR in order to develop targeted strategies to decrease the burden of this disease. Within the cancer continuum, along with morbidity and mortality, determining survival of anal cancer gives an opportunity to explore health disparities. Therefore, this study aimed to determine the relative 1- and 3-year survival after diagnosis of anal cancer for the period of 2000 to 2007 in PR.
Methods Inclusion Criteria To assess the relative survival of anal cancer in PR (1 and 3 years) for men and women, we analyzed the incidence and mortality information for anal cancer cases reported to the PR Central Cancer Registry (PRCCR) for the period of 2000– 2007. All histological types of cancer of the anus, anal canal, and anorectum (ICD-O-3 codes C210-C218), except for sarcoma, for the period of 2000–2007 were included. For the analyses focused on histologies, tumors were categorized by histological type according to the International Classification of Diseases for Oncology (ICD-O-3) as follows: squamous cell carcinoma (codes 8010 and 8051-8081), cloacogenic (including basaloid codes 8120-8124), and adenocarcinoma (codes 8140-8263 and 8480-8481). The survival analysis was limited only to patients who had a first primary anal tumor that was confirmed microscopically and had invasive disease. The follow-up period of patients was until the date of death or December 31, 2010 (whichever occurred first). Exclusion Criteria For the period of 2000 to 2007, 417 cases of anal cancer were reported to the PRCCR. Cases were excluded from the analysis
235
if the anal cancer was not the patient’s primary cancer, cases identified through autopsy, or death certificate only were also excluded. Also, as in other similar studies in the literature [7], cases without microscopic confirmation and tumors identified as in situ lesions were excluded. After these exclusions, 228 cases remained for the survival analysis. Statistical Analysis Relative survival was estimated with the use of life tables (stratified by age, sex, and calendar time) from the population of PR [8], as the ratio of the observed survival of the patients (where all deaths are considered events) to the expected survival, using the strs command in STATA/IC 12.0 [9]. In addition, the excess survival was compared by age at diagnosis, histology, and stage (defined as local, regional, or distant), using the Poisson regression model.
Results Descriptive statistics for anal cancer by age at diagnosis, stage, and histology are shown in Table 1. A higher proportion of anal cancer cases were observed in women, as compared with men. An inverse proportion in anal cancer cases by age group was observed by gender. A higher proportion of cases in men were in the
