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Demographics and incidence of anal squamous cell carcinoma in people living in high HIV prevalence geographical areas
  1. Danielle Rebecca Louise Brogden1,2,
  2. Christos Kontovounisios1,2,
  3. Sundhiya Mandalia1,
  4. Paris Tekkis1,2,
  5. Sarah Catherine Mills1,2
  1. 1Faculty of Medicine, Imperial College London, London, UK
  2. 2Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Christos Kontovounisios, Imperial College London Faculty of Medicine, London, UK; c.kontovounisios{at}imperial.ac.uk

Abstract

Objectives Anal squamous cell carcinoma (ASCC) is an uncommon cancer that is rapidly increasing in incidence. HIV is a risk factor in the development of ASCC, and it is thought that the rapidly increasing incidence in men is related to increasing numbers of people living with HIV (PLWH). We undertook a population-based study comparing the demographics and incidence of ASCC in patients residing high HIV prevalence areas in England to patients living in average HIV prevalence areas in England.

Methods This is a cross-sectional study following the ‘Strengthening the Reporting of Observational Studies in Epidemiology’ statement. Demographic data and incidence rates of ASCC within Clinical Commissioning Groups (CCGs) between 2013 and 2018 were extracted from the Cancer Outcomes and Services Dataset. CCGs were then stratified by HIV prevalence from data given by Public Health England, and high HIV prevalence geographical areas were compared with average HIV geographical areas.

Results Patients in high HIV areas were more likely to be young and male with higher levels of social deprivation. Incidence rates in men between 2013 and 2017 were higher in high HIV areas than average HIV areas with a rapidly increasing incidence rates in early-stage disease and a 79.1% reduction in incidence of metastatic stage 4 disease.

Whereas women in high HIV areas had lower ASCC incidence than the national average and a low incidence of early-stage disease; however, metastatic disease in women had quintupled in incidence in high HIV areas since 2013.

Conclusions Patients presenting with ASCC in high HIV geographical areas have different demographics to patients presenting in average HIV geographical areas. This may be related to screening programmes for PLWH in high HIV areas.

  • HIV
  • epidemiology
  • gastroenterology
  • genital neoplasms
  • female
  • genital neoplasms
  • male

Data availability statement

Data may be obtained from a third party and are not publicly available. Data are available from Public Health England on request.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data are available from Public Health England on request.

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Footnotes

  • Handling editor Jason J Ong

  • Twitter @dannibrogden

  • Contributors All listed authors confirm that they had made substantial contribution to either the conception, design, acquisition, analysis and interpretation of the data and either drafted the original article or provided critical revisions or prior drafts. All authors had access to the dataset prior and during analysis, DRLB verified the data before analysis and acts as an guarantor.

  • Funding This work was supported by the Red Trouser Day Charity (grant number: not applicable).

  • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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