Latest news with #analcancer
Medscape
06-08-2025
- Health
- Medscape
Detecting Anal Cancer in Vulnerable Patients
WASHINGTON — Anal cancer is a major issue in the older adult population, especially for those identifying as sexually diverse, and it is 'not yet talked about enough,' Klint Peebles, MD, said at the ElderDerm 2025 conference on dermatology in the older patient population. Between 2001 and 2015, the incidence of anal squamous cell carcinoma rose 2.7% per year in the US, according to a published analysis of the US Cancer Statistics dataset, with statistically significant increases in people aged 50 years or older, especially in women. Moreover, deaths from anal cancer rose 3.1% each year during that period. 'Not only are rates rising, but we're seeing later-stage diagnoses rise as well,' said Peebles, a dermatologist with Kaiser Permanente, Mid-Atlantic Permanente Medical Group, in Washington, DC, and suburban Maryland. 'We're not catching them early in certain groups.' Peebles discussed this issue in a presentation titled 'Intersection of aging, gender & sexual diversity, and dermatology' at the meeting hosted by the George Washington School of Medicine and Health Sciences, Washington, DC. Klint Peebles, MD In 2024, there were an estimated 10,540 new cases of anal cancer (0.5% of all new cancer cases), with higher rates in women than in men. Notably, in women aged 65-74 years or older, anal cancer is more common than cervical cancer. Cervical cancer screening generally ends at age 65 for women at average risk. But anal cancer hasn't even peaked in this population by then, Peebles noted, referring to a 2021 report from the HPV Information Centre. 'For men, it starts to peak at age 60 or so and then never comes down.' Among subpopulations, people living with HIV — and especially men who have sex with men (MSM) who are living with HIV — have the highest rates of anal cancer. 'Men who have sex with men and living with HIV are 80 times more likely to develop anal cancer than HIV-negative individuals,' Peebles said. One in 10 MSM living with HIV will get anal cancer over their lifetime, and 'we're seeing this happen regardless of antiretroviral therapy.' Challenges, Disparities of a Growing Population Understanding the epidemiology of anal cancer is part of the broader need for dermatologists to recognize the health challenges faced by LGBTQ older adults, said Peebles, chair of the American Academy of Dermatology (AAD)'s Access to Dermatologic Care Committee and past chair of the AAD's LGBTQ/Sexual and Gender Minority Expert Resource Group. An estimated 250,000 US adults older than 65 years identify as transgender, about 0.5% of that age group, mirroring the proportion in the general population. An estimated 3 million LGBTQ adults older than 50 years currently live in the US, and that's expected to grow to 7 million by 2030. Many LGBTQ older adults face significant economic, housing, and healthcare barriers rooted in a lifetime of discrimination. More than half report employment and/or housing discrimination, and one third live at or below the federal poverty level. Among LGBTQ seniors, 'there are many concerns about long-term care settings,' Peebles added, 'with many trans older adults being forced, for instance, to hide their identify in order to get accepted' into long-term care and to feel safe and secure there. These disparities can directly influence dermatologic care, emphasized Peebles, who urged dermatologists to provide trauma-informed care, which is a distinct evidence-based model that acknowledges the substantial impact of trauma while offering the necessary support for healing. In addition, it is important to differentiate between sex/sex assigned at birth, gender identity, gender expression, sexual orientation, and sexual behavior. 'All of these are very different,' Peebles said. An Important Start on Anal Cancer Screening The ANCHOR trial conducted at 25 US clinical sites and published in The New England Journal of Medicine in 2022, demonstrated that routine screening for and removal of anal high-grade squamous intraepithelial lesions could significantly lower the risk for anal cancer in people living with HIV. The findings informed the first federal screening guidelines released in 2024, co-sponsored by the Office of AIDS Research at the National Institutes of Health, the CDC, and the HIV Medicine Association affiliated with the Infectious Diseases Society of America. The guidelines recommend that all adults living with HIV be assessed at least once a year for anal abnormalities and undergo digital anorectal examination. Those younger than 35 years with anal symptoms or abnormalities on examination should undergo standard anoscopy, people older than 35 years should have laboratory-based screening (with follow-up high-resolution anoscopy, if indicated) if they are MSM, transgender women, or aged 45 years or older. Consensus screening guidelines from the International Anal Neoplasia Society similarly recommend screening in all MSM and transgender women living with HIV who are aged 35 years or older. A lower risk category for screening requiring shared decision-making recommends screening for those with perinatal warts who are 45 years or older. 'I've helped to identify a handful of invasive anal cancers over the last year alone in the older adult population who are living with HIV and identify as MSM,' Peebles said at the meeting. 'This was only after I initiated the conversation about their risk factors for anal cancer, which then led to appropriate screening,' Peebles explained after the meeting. A 2018 survey sponsored by the American Association of Retired Persons and the University of Michigan found that about 40% of people aged 65-80 years are sexually active, condom use is low, and only 17% had discussed sexual health with their healthcare provider in the prior 2 years. 'It is important to remember this context, to gather relevant information about sexual behaviors, and to remember that sexual behaviors are entirely distinct from sexual orientation and attraction,' Peebles told Medscape Medical News after the meeting.
Daily Mail
27-06-2025
- Health
- Daily Mail
Secret sign of cancer you could have missed revealed as expert makes grave warning
A doctor has revealed the secret signs of anal cancer - and why it's often confused for something else. Dr. Goldstein explained around 90 percent of anal cancers - dubbed the 'silent disease' due to its lack of symptoms - stem from the human papillomavirus (HPV) - and anal warts. 'Anal cancer stems from the HPV virus and, for many, from the development of anal warts,' Dr. Goldstein, founder and CEO of Bespoke Surgical and Future Method, told New York Post. The expert explained this could look like a single bump near the anus or as a cluster that resembles cauliflower, which can be raised or flat. 'Many think they are just skin tags and then find out it's anal warts from HPV,' said Dr. Goldstein, who also authored: Butt Seriously: The Definitive Guide to Anal Health, Pleasure and Everything In Between. He described anal warts as 'painful and itchy' and said they can 'lead to bleeding.' Treatment includes topical medications, cryotherapy or surgical removal, although some patients don't have any symptoms and may not know they have anal warts. The body's immune system often clears HPV infections naturally, usually within a few years, but some linger. While nine out of 10 HPV infections go away on their own, Johns Hopkins notes if the infection becomes persistent or more severe due to a weakened immune system, HPV can cause cancers later in life, including anal cancer. The risk of developing anal cancer is around one in 500, according to the American Cancer Society. The site noted that this number was particularly high among white and Hispanic women over the age of 65. Anal cancer symptoms can be similar to those of hemorrhoids and anal fissures, sometimes making it harder to diagnose. The main symptoms are bleeding from the anus, itching and pain, as well small lumps around and inside your bottom and a discharge of mucus and inconsistent stool. 'The idea is to catch this early with early detection anal pap smears and full anoscopy with an appropriate anal practitioner,' Dr. Goldstein explained. 'The more we talk about anal health and standardize yearly evaluations, similar to genecology appointments, the better all of us will be,' he added. Dr. Goldstein often shares information about anal health, revealing a critical mistake people are making after using the toilet, explaining it could lead to serious health issues over time. The leading proctologist says 'traditional wiping' with toilet paper is causing unnecessary damage and is even more concerned about the popularity of using wet wipes to complete the job. Speaking to HuffPost for Am I Doing It Wrong? Dr Goldstein explained that the skin around the anus is sensitive, and wiping with toilet paper can easily lead to irritation, small tears, and long-term damage. It's a problem that he sees far too often in his clinic, and it's only getting worse as more people rely on wet wipes for a 'cleaner' finish. 'They are so terrible - not only for the environment, but for your hole,' he said. 'There's so many companies out there throwing wipes and I think they should all be banned. I see 90 people a week [in my office], and I would say one-third of all the people coming through are coming in from wet wipe-induced issues.' According to Dr Goldstein, wet wipes are soaked in chemicals which can disrupt the microbiome of the area, which can lead to bacterial infections and painful skin conditions.
Medscape
17-06-2025
- Health
- Medscape
Anal Cancer Screening Benefits HIV-Positive MSM at Age 35
Analysis reveals initiating anal cancer screening at age 35 years or older among men who have sex with men (MSM) with HIV is cost-effective. A greater value was seen if screening was started at 35 years than at 40-45 years of age. METHODOLOGY: MSM with HIV face a markedly elevated risk for anal cancer, with an incidence of 85 cases per 100,000 persons. The Anal Cancer-HSIL Outcomes Research (ANCHOR) trial recently demonstrated that anal high-grade squamous intraepithelial lesion (HSIL) treatment reduces anal cancer risk among people with HIV. A microsimulation model was developed to simulate the life course of MSM with HIV, including natural histories of HIV, human papillomavirus(HPV), HSIL, and anal cancer. Analysis included MSM with HIV aged 35 years or older in 2019 for the base-case analysis, with additional sensitivity analyses for newly eligible cohorts at 5-year increments up to age 55 years. Researchers evaluated cytology alone, HPV testing options, co-testing, and triage strategies across different screening intervals (annual, biennial, triennial, or quadrennial). Outcome measures encompassed incremental cost-effectiveness ratios in dollars per quality-adjusted life-year and tradeoff of harms vs benefits. TAKEAWAY: Without screening, researchers predicted 4064 anal cancer cases and 680 deaths would occur over the lifetime of 100,000 MSM with HIV aged 35 years or older. Screening initiation at age 35 years demonstrated greater value than starting at age 40 or 45 years, with incremental cost-effectiveness ratio, $87,731 for quadrennial intervals to $350,100 for annual intervals. The quadrennial HPV16/18 strategy remained cost-effective through age 55 years, supporting screening initiation up to this age. Compared with no screening, anal cancer mortality reduction ranged from 25.8% for quadrennial cytology with HPV16 triage to 63.1% for annual cytology with high-risk HPV co-testing. IN PRACTICE: 'Our model estimated that annual cytology screening among MSM with HIV aged 35 years or older could reduce anal cancer mortality by up to 65% and found that triennial cytology was cost-efficient vs screening at age 40 or 45 years or older and cost-effective vs no screening. In our comparative effectiveness analysis, HPV-based screening, particularly triennial testing for HPV16/18, was efficient,' the authors of the study wrote. SOURCE: This study was led by Ashish A. Deshmukh, PhD, MPH, Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina in Charleston, South Carolina. It was published online on June 17 in Annals of Internal Medicine . LIMITATIONS: This study assumed perfect adherence to all screening, diagnosis, and follow-up treatments, which may not reflect real-world conditions. In 2019, only 5% of people with HIV in the US had been screened for anal cancer in the preceding 12 months, likely due to the absence of consensus recommendations and limited high-resolution anoscopy capacity. Additionally, in settings with available screening resources, treatment uptake was poor and attrition during surveillance was common, which may alter the overall effectiveness and relative harm-to-benefit ratios of screening strategies. DISCLOSURES: This study was supported by the National Cancer Institute of the National Institutes of Health. The findings and conclusions contained in the study do not necessarily reflect the positions or policies of the National Institutes of Health.
Daily Mail
04-06-2025
- General
- Daily Mail
I blamed an embarrassing symptom on menopause... it was actually stage 3 anal cancer
Julia DeVillers never imagined a common sexually transmitted infection she had in college would be the cause of her rare cancer decades later. DeVillers, an author, began experiencing random gushes of blood, seeing red in her underwear. She blamed the bleeding on early signs of menopause - as a woman in her fifties, she figured it was time. One day, she sat poolside and saw blood had soaked the towel beneath her. She said: 'I bled on it, and I thought, 'Wow, this brings me back to my pre-teen years of being traumatized when you get your fist period." I thought, 'This is a very dramatic period.'' Early symptoms of perimenopause, the period preceding menopause, include irregular bleeding of various flows and lengths - but what DeVillers didn't realize was that the bleeding was coming from her anus, not her vagina. She said: 'I didn't know the bleeding was coming from my tush. I thought I was getting my period again.' When she realized, however, she knew bleeding from the anus could be a sign of cancer. Doctors suspected a hemorrhoid to be the culprit, and performed surgery to remove it. But instead of finding swollen veins, doctors found two tumors. She had stage three anal cancer - a rare cancer linked to the STI human papillomavirus (HPV). 'It wasn't non-stop. All of a sudden, I would have a gush of blood. I really begged them to put me on a waiting list [for hemorrhoid removal surgery],' she told TODAY. Her surgery in May 2022 was expected to be a standard, straightforward procedure that would put an end to her suffering. 'When I came out of it, I was really groggy from the anesthesia, but I remember my husband was holding one hand and my doctor was holding the other hand,' DeVillers said. The anal cancer cells had migrated to her lymph nodes, making it stage 3. Between 40 and 70 percent of patients die within five years of being diagnosed with this stage of cancer. Anal cancer, which develops in the anal canal, is rare, with 10,540 new cases in 2024 and 2,190 deaths. It is different from colon or rectal cancer and is typically caused by an HPV infection. In an article DeVillers wrote for Newsweek, she said: 'I'd been married for a million years! But I also remembered back in college my gynecologist saying: "You have human papillomavirus (HPV), don't worry it's common, harmless, and will probably go away by itself."' Estimates suggest 80 percent of sexually active people will contract at least one HPV infection by 45. It is spread via skin-to-skin contact through vaginal, anal or oral sex. It often shows no symptoms. According to the CDC, more than 42million Americans are currently infected with the STI and it is estimated 13million people become infected annually. It is possible to fend off HPV and potentially related cancers with a vaccine for the virus that is 97 percent effective. Doctors prescribed DeVillers with aggressive IV chemotherapy, as well as radiation treatments and oral chemotherapy. Just before three weeks into her treatment and her second chemo infusion, she was doing well, but after her second infusion, she 'seemed to crash and burn,' she told TODAY. Her colon became twisted, causing excruciating pain. She vomited neon green bile and then collapsed in the emergency department. She ended up spending five weeks in the intensive care unit. Doctors noticed her blood cell counts had plummeted, and called her children because they were unsure how much time DeVillers had left. They also enlisted hospice care. 'That was horrible for my family,' she said, adding she could feel her body shutting down. 'I saw this dark tunnel and it had two pricks of white light,' DeVillers said. This lasted 'a day or two and I felt darkness. I was very depressed.' But she began to feel better after a blood transfusion. DeVillers had lost about 30 pounds and became weak and frail, but her cancer had not shrunk enough to get her closer to remission, and she still had to undergo radiation treatment. 'Even as sick as I was, they wheeled me into radiation,' she said. 'My radiologist, I'll forever be grateful for him. He said, 'If we stop now, it could come back. But if we keep going to radiation … that's what's going to get rid of the tumor.'' When her treatment ended in August 2022, doctors approached her with 'cautious good news.' There were no signs of cancer remaining, though they were still worried about a lymph node that had caused a lump in her abdomen. Six months later, though, she was cancer-free. It's been three years since her diagnosis and all of her tests continue to be normal. DeVillers felt embarrassed by her cancer at first. When people asked her about it, she said: ''Yeah, I've got tush cancer.'' 'Anything so I didn't have to say anal and then I learned anal cancer is a different animal from rectal or colon cancer.' Now, she's joined the board of the HPV Cancer Alliance to remove the stigma and raise awareness of HPV-related cancers. She said: 'Women get it. Men get it. It's all directly related to getting HPV.'
Medscape
16-05-2025
- Business
- Medscape
Retifanlimab Wins Upfront Indication for Anal Cancer
The US Food and Drug Administration has approved two new indications for the PD-1-blocking antibody, retifanlimab-dlwr (Zynyz, Incyte), both for locally recurrent or metastatic squamous cell anal carcinoma. The first indication is for upfront treatment of inoperable disease in combination with carboplatin and paclitaxel; the second is as monotherapy following progression on or intolerance to platinum-based chemotherapy. The National Comprehensive Cancer Network recommends other PD-1 blockers for second line treatment of anal cancer, but retifanlimab-dlwr is the first one to win a formal first-line indication. Until now, standard upfront treatment has been limited to chemotherapy. 'This approval marks an important advancement as it makes a new treatment approach available for this challenging cancer,' Marwan Fakih, MD, an Incyte researcher and medical gastrointestinal oncologist at City of Hope, Los Angeles, said in a company press release. Retifanlimab-dlwr was previously approved in 2023 for metastatic or recurrent locally advanced Merkel cell carcinoma. The new first-line anal cancer indication with carboplatin and paclitaxel was based on the POD1UM-303/InterAACT 2 trial in 308 chemotherapy-naive, inoperable subjects, including some with well-controlled HIV infection. Patients in this trial were randomized to retifanlimab-dlwr 500 mg IV every 4 weeks or placebo on a background of carboplatin and paclitaxel for six cycles. Median progression-free survival was 9.3 months with retifanlimab-dlwr vs 7.4 months with placebo. Overall survival (OS) assessment is ongoing, but on interim analysis, median OS was 29.2 months in the retifanlimab-dlwr arm vs 23 months, with 45% of placebo patients moving onto retifanlimab-dlwr after disease progression. OS results were not statistically significant. Approval for the second-line monotherapy indication was based on the single-arm POD1UM-202 trial in 94 patients with disease progression on or intolerance to platinum-based chemotherapy. The dosage was again 500 mg IV every 4 weeks. The overall response rate was 14%, and the median duration of response was 9.5 months. Serious adverse reactions occurred in 47% of patients who received retifanlimab-dlwr with chemotherapy. The most common were sepsis, pulmonary embolism, diarrhea, and vomiting, according to the company press release. In the monotherapy study, serious adverse reactions occurred in 40% of patients, the company press release says. The most frequent, in 2% or more, were non-urinary tract infection, perineal pain, abdominal pain, anemia, hemorrhage, diarrhea, pyrexia, urinary tract infection, musculoskeletal pain, and dyspnea. The approved dose is the same as in the trials, 500 mg IV every 4 weeks until disease progression or unacceptable toxicity for up to 12 months in the first line indication and for up to 24 months in the second new indication. The cost of a single 500 mg/20 mL dose is $15,748.45, according to Incyte has a program called IncyteCARES that offers financial assistance and other support for those who qualify. Information is available at or by calling 1-855-452-5234.
