Anal cancer incidence and survival: comparing the greater San-Francisco bay area to other SEER cancer registries

Abstract

The incidence of squamous cell carcinoma of the anus, anal canal, and anorectum (SCCA) has increased over time. However, there are still no national guidelines on screening for SCCA among high-risk populations. Providers at University of California, San Francisco have been at the forefront of providing anal dysplasia screening. To determine whether such a screening program allows for earlier detection of abnormalities and consequently, improves patient survival, we conducted an ecological study using data from the Surveillance, Epidemiology, and End Results (SEER) program to compare the San Francisco-Oakland catchment area (SF-O) to other SEER sites where routine screening has not been as accessible. Cox regression models were utilized to assess the impact of residing in the SF-O region, versus other SEER sites, on cause-specific mortality hazard. Logistic regression was used to determine if site was associated with the probability of having an in situ versus invasive tumor among SCCA cases. All analyses were stratified on calendar time (1985-1995 and 1996-2008) to compare differences pre- and post- highly active anti-retroviral therapy. Among SCCA cases, being reported by the SF-O registry was associated with a four fold higher probability of having an in situ tumor (rather than an invasive tumor) [95% CI: 3.48-4.61], compared to sites outside of California, between 1996 and 2008. Cases reported from the SF-O region between 1996 and 2008 had a 39% lower mortality risk than those reported from registries outside California (95% CI: 0.51-0.72). However, there was no decrease in the rate of invasive SCCA over this period. This is the first ecological study to evaluate whether access to anal cancer screening programs may help improve patient survival by allowing for earlier detection of lesions. Our results imply that routine screening programs may help detect SCCA at an earlier stage and thus, potentially impact patient survival.

Conflict of interest statement

Competing Interests: One of the co-authors, Michael E. Scheurer, is a member of the PLOS ONE Editorial Board. However, this does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Age-standardized incidence* of squamous cell carcinoma of the anus, anal canal, and anorectum between 1996 and 2008 by sex and SEER registry site, San Francisco-Oakland (SF-O), other California sites (CA), and all other registries.

A. Overall; B. Among Men; C. Among Women. Footnote: *Includes in situ cases. X-axis: Year. Y-axis: per 100,000 person-years.

Figure 2. Incidence of in situ and metastatic squamous cell carcinoma of the anus, anal canal, and anorectum among men in San Francisco-Oakland (SF-O) compared to all other SEER sites.

A. Pre-highly active antiretroviral therapy era (HAART); B. Post-HAART. X-axis. Year. Y-axis: per 100,000 person-years.

Figure 3. Kaplan-Meier curves comparing cause-specific* survival distributions between the San Francisco-Oakland Registry (SF-O), other California registries (CA), and all other SEER registries (1996–2008), both overall and by sex: A. Overall by registry site (log rank p

Footnote: *All reported cases, including in situ, were included in these survival curves.

Figure 4. Kaplan-Meier curves comparing cause-specific survival distributions among cases with in situ (A), locally/regionally extended (B), and metastic (C) tumors between the San Francisco-Oakland Registry (SF-O), other California registries (CA), and all other SEER registries (1996–2008).