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2700-12-31
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INCIDENCE AND TIME TRENDS OF ANAL CANCER IN SÃO PAULO, BRAZIL, 2000-2015
Darko, Eric Kwame Karikari | Date Issued:
2021
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Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Abstract in Portuguese
Introduction: Increasing rates of anal cancer (AC) has been reported in developed countries and mostly driven by anal squamous cell carcinoma (ASCC) which are high-risk HPV induced, and thus, potentially reduced by HPV vaccination. Scarce data on the burden of AC are available in developing countries. We aimed to study the trends in the AC incidence in the municipality of Sao Paulo, Brazil, from 2000 to 2015. Method: This was a time trends analysis of ASCC and anal adenocarcinoma (AADC) incidence. Data on AC was obtained from the Population Based Cancer Registry of Sao Paulo. Age-specific incidence rates (IRs) were estimated, and Poisson regression model was used to compare incidence of AC across four calendar time-period, sex and age at diagnosis. Results: 2.173 ACs cases were registered: 1.296 (59.6%) ASCC, 371 (17.1%) AADC and 506 (23.3%) other types. Most ASCC and AADC cases were found in women (n=1173; 70.4%) with an annual IR of 6.2 (95%CI:5.8-6.5) vs. 2.9/1.000.000 (95%CI:2.6-3.1) in men. Median age at diagnosis was higher among women than men for both ASCC [Women:60(IQR:52-70); Men:53(IQR:45-64)] and AADC [Women: 67(IQR:55-78); Men:63 IQR:52.5-73)]. ASCC IR increased in 2009-2012 (IRR:1.2; 95%CI:1-1.4) while AADC IR increased in 2005-2008 (IRR:1.6;95%CI:1.4-1.7) compared to 2000-2004, both with subsequent decreases. The IRs of ASCC and ADCC significantly increased in people aged 45-59 [ASCC: IRR:12(95%CI:9-16) and AADC: IRR:12.2(95%CI:9.8-15.2)] and 60+ [ASCC: IRR:21(95%CI:15.7-28.2) and AADC: IRR:39.2(95%CI:32.5-48.9)] compared to those aged less than 45 years. ASCC IR was 50% lower in men than in women (IRR:0.5; 95%CI:0.4-0.6) and no differences by sex were observed in IRs of AADC. Conclusion: ASCC was the most frequent AC, with higher incidence rates among women, however men were more propended to develop this type of cancer at an earlier age than women. AADC IRs increased earlier in the calendar time-period while ASCC increased later, followed both by declines. Target groups should be considered in time trend analysis to monitor the impact of HPV vaccination and AC screening strategies considering HIV Test&Treat and pre exposure prophylaxis (PrEP) availability
Abstract
Introduction: Increasing rates of anal cancer (AC) has been reported in developed countries and mostly driven by anal squamous cell carcinoma (ASCC) which are high-risk HPV induced, and thus, potentially reduced by HPV vaccination. Scarce data on the burden of AC are available in developing countries. We aimed to study the trends in the AC incidence in the municipality of Sao Paulo, Brazil, from 2000 to 2015. Method: This was a time trends analysis of ASCC and anal adenocarcinoma (AADC) incidence. Data on AC was obtained from the Population Based Cancer Registry of Sao Paulo. Age-specific incidence rates (IRs) were estimated, and Poisson regression model was used to compare incidence of AC across four calendar time-period, sex and age at diagnosis. Results: 2.173 ACs cases were registered: 1.296 (59.6%) ASCC, 371 (17.1%) AADC and 506 (23.3%) other types. Most ASCC and AADC cases were found in women (n=1173; 70.4%) with an annual IR of 6.2 (95%CI:5.8-6.5) vs. 2.9/1.000.000 (95%CI:2.6-3.1) in men. Median age at diagnosis was higher among women than men for both ASCC [Women:60(IQR:52-70); Men:53(IQR:45-64)] and AADC [Women: 67(IQR:55-78); Men:63 IQR:52.5-73)]. ASCC IR increased in 2009-2012 (IRR:1.2; 95%CI:1-1.4) while AADC IR increased in 2005-2008 (IRR:1.6;95%CI:1.4-1.7) compared to 2000-2004, both with subsequent decreases. The IRs of ASCC and ADCC significantly increased in people aged 45-59 [ASCC: IRR:12(95%CI:9-16) and AADC: IRR:12.2(95%CI:9.8-15.2)] and 60+ [ASCC: IRR:21(95%CI:15.7-28.2) and AADC: IRR:39.2(95%CI:32.5-48.9)] compared to those aged less than 45 years. ASCC IR was 50% lower in men than in women (IRR:0.5; 95%CI:0.4-0.6) and no differences by sex were observed in IRs of AADC. Conclusion: ASCC was the most frequent AC, with higher incidence rates among women, however men were more propended to develop this type of cancer at an earlier age than women. AADC IRs increased earlier in the calendar time-period while ASCC increased later, followed both by declines. Target groups should be considered in time trend analysis to monitor the impact of HPV vaccination and AC screening strategies considering HIV Test&Treat and pre exposure prophylaxis (PrEP) availability
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