Squamous cell carcinoma of the anus (SCCA) incidence and mortality rates are rising in the United States. Understanding state-level incidence and mortality patterns and associations with smoking and AIDS prevalence (key risk factors) could help unravel disparities and provide etiologic clues.

Using the US Cancer Statistics and the National Center for Health Statistics data sets, we estimated state-level SCCA incidence and mortality rates. Rate ratios (RRs) were calculated to compare incidence and mortality in 2014-2018 versus 2001-2005. The correlations between SCCA incidence with current smoking (from the Behavioral Risk Factor Surveillance System) and AIDS (from the HIV Surveillance system) prevalence were evaluated using Spearman's rank correlation coefficient.

Nationally, SCCA incidence and mortality rates (per 100,000) increased among men (incidence, 2.29-3.36, mortality, 0.46-0.74) and women (incidence, 3.88-6.30, mortality, 0.65-1.02) age ≥ 50 years, but decreased among men age < 50 years and were stable among similar-aged women. In state-level analysis, a marked increase in incidence (≥ 1.5-fold for men and ≥ two-fold for women) and mortality (≥ two-fold) for persons age ≥ 50 years was largely concentrated in the Midwestern and Southeastern states. State-level SCCA incidence rates in recent years (2014-2018) among men were correlated (r = 0.47, P < .001) with state-level AIDS prevalence patterns. For women, a correlation was observed between state-level SCCA incidence rates and smoking prevalence (r = 0.49, P < .001).

During 2001-2005 to 2014-2018, SCCA incidence and mortality nearly doubled among men and women age ≥ 50 years living in Midwest and Southeast. State variation in AIDS and smoking patterns may explain variation in SCCA incidence. Improved and targeted prevention is needed to combat the rise in SCCA incidence and mitigate magnifying geographic disparities.

CONTEXT

Key Objective

What are the recent incidence and mortality patterns in human papillomavirus (HPV)–associated squamous cell carcinoma of the anus (SCCA) in association with state-level prevalence of HIV/AIDS and smoking (key oncogenic cofactors)?

Knowledge Generated

Recently, a more than 1.5-fold rise in anal cancer incidence among persons age ≥ 50 years occurred. A correlation with smoking prevalence patterns was observed for women. For men, SCCA incidence patterns were correlated with HIV/AIDS prevalence patterns. Increases in anal cancer incidence and mortality rates call for improvements in primary (ie, HPV vaccination) and secondary (early detection approaches) prevention and urgent treatment advances.

Relevance (E. M. O'Reilly)

This article describes important epidemiologic trends that have occurred over the past two decades related to the incidence of SCCA in the United States and suggests opportunities for public health interceptions related to smoking cessation, HPV vaccination, and early detection strategies.*

*Relevance section written by JCO Associate Editor Eileen M. O'Reilly, MD.

Supported by the National Cancer Institute of the National Institutes of Health under Award Numbers R01CA232888 (A.A.D.), R01CA256660 (A.A.D., K.S., E.C.), 5R01CA232890 (E.Y.C.), U54CA096300 (A.A.D., A.P.O.), U54CA096297 (A.A.D., A.P.O.), and K01MD016440 (K.S.).

Conception and design: Haluk Damgacioglu, Ana Patricia Ortiz, Keith Sigel, Vivian Colon Lopez, Elizabeth Y. Chiao, Kalyani Sonawane, Ashish A. Deshmukh

Financial support: Keith Sigel, Kalyani Sonawane, Ashish A. Deshmukh

Administrative support: Ashish A. Deshmukh

Provision of study materials or patients: Ashish A. Deshmukh

Collection and assembly of data: Haluk Damgacioglu, Gregory M. Barnell, Kalyani Sonawane, Ashish A. Deshmukh

Data analysis and interpretation: Haluk Damgacioglu, Yueh-Yun Lin, Ana Patricia Ortiz, Chi-Fang Wu, Zahed Shahmoradi, Shiang Shiuan Shyu, Ruosha Li, Alan G. Nyitray, Keith Sigel, Gary M. Clifford, Naomi Jay, Vivian Colon Lopez, Elizabeth Y. Chiao, Elizabeth A. Stier, Karen J. Ortiz-Ortiz, Jeslie M. Ramos-Cartagena, Kalyani Sonawane, Ashish A. Deshmukh

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

State Variation in Squamous Cell Carcinoma of the Anus Incidence and Mortality, and Association With HIV/AIDS and Smoking in the United States

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

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Ana Patricia Ortiz

Consulting or Advisory Role: Merck

Research Funding: Merck (Inst)

Alan G. Nyitray

Research Funding: COPAN (Inst)

Travel, Accommodations, Expenses: EUROGIN

Keith Sigel

Employment: Oscar Health (I)

Stock and Other Ownership Interests: Amarin Corporation, Adial Pharmaceuticals (I), Biohaven Pharmaceuticals (I), Axsome Therapeutics (I)

Naomi Jay

Honoraria: Roche

Vivian Colon Lopez

Consulting or Advisory Role: Merck

Karen J. Ortiz-Ortiz

Research Funding: AbbVie (Inst), Merck (Inst)

Kalyani Sonawane

Consulting or Advisory Role: Value Analytics Labs

Ashish A. Deshmukh

Consulting or Advisory Role: Merck, Value Analytics Labs

No potential conflicts of interest were reported.