Background/Objectives: Women carry two-thirds of the global anal cancer burden. Persistent genital (vulval, vaginal and cervical) high-risk Human Papillomavirus (hrHPV) infection and the resultant genital high-grade squamous intraepithelial lesions (HSILs) and genital cancers are now acknowledged as independent risk factor for anal dysplasia in women. Patients with both genital and anal hrHPV-related diseases, however, are poorly researched.Methods: National Cancer Registration and Analysis Service (NCRAS) data was requested via the NHS Digital data access request service (DARS). Women in England over the age of 25 years diagnosed with anal HSIL/cancer between 2001 and 2020 who also had a vulval and/or vaginal and/or cervical cancer HSIL/cancer diagnosis within the 20-year period before or 1-year period after their anal cancer/HSIL were studied. The burden of genital disease in women with anal cancer, their sociodemographic risk factors and timelines between acquisition of genital and anal pathology were assessed.Results: A total of 8% (n= 1297/16,301) of all women with anal HSIL/cancer also had metachronous or synchronous genital HSIL/cancer diagnoses. Women who were first diagnosed with cervical HSIL had a lower burden of recurrent anogenital lesions over time (p= 0.04) but a significantly higher risk of presenting with late-stage anal cancer than women first presenting with vulval pathology (p= 0.02). Women who had disease in more than one anatomical site developed disease features 10–20 years earlier compared to other published datasets on women with single site disease.Conclusions: These findings support the current IANS screening recommendation guidelines and suggest that the current anal cancer risk for women with cervical dysplasia may be underestimated.
背景/目的：女性承担了全球三分之二的肛门癌负担。持续存在的生殖器（外阴、阴道和宫颈）高危型人乳头瘤病毒（hrHPV）感染及其导致的生殖器高级别鳞状上皮内病变（HSIL）和生殖器癌症，现已被公认为女性肛门异型增生的独立危险因素。然而，对于同时患有生殖器和肛门hrHPV相关疾病的患者，目前研究尚不充分。 方法：通过英国国家医疗服务体系数字数据访问请求服务（DARS）获取国家癌症登记与分析服务（NCRAS）的数据。研究对象为2001年至2020年间在英格兰被诊断为肛门HSIL/癌症的25岁以上女性，这些女性在其肛门癌/HSIL诊断前20年内或诊断后1年内，同时被诊断出患有外阴和/或阴道和/或宫颈癌HSIL/癌症。研究评估了肛门癌女性患者的生殖器疾病负担、其社会人口学危险因素，以及生殖器与肛门病变发生的时间线。 结果：在所有肛门HSIL/癌症女性患者中，总计8%（n=1297/16301）同时存在异时性或同步性生殖器HSIL/癌症诊断。首次诊断为宫颈HSIL的女性，随时间推移其肛门生殖器复发性病变负担较低（p=0.04），但与首次表现为外阴病变的女性相比，其晚期肛门癌的发病风险显著更高（p=0.02）。与已发表的其他单部位病变女性数据集相比，在多个解剖部位发生病变的女性，其疾病特征的出现时间提前了10至20年。 结论：这些发现支持了当前IANS筛查推荐指南，并提示目前对宫颈异型增生女性患者的肛门癌风险可能被低估。
Women with HPV-Driven Anal and Genital Disease: Investigating the Patient Cohort in England
肿瘤(癌症)患者之家