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BMJ. 1993 February 13; 306(6875): 419–422.
PMCID: PMC1676495

Trends in incidence of anal cancer in Denmark.


OBJECTIVE--To study long term trends in incidence of anal cancer in a well monitored, unselected population. DESIGN--Descriptive epidemiological study based on data from the Danish Cancer Registry. SETTING--Denmark, 1943-87. MAIN OUTCOME MEASURES--Time related changes in anal cancer incidence according to sex, age, birth cohort, urban or rural residence, and marital status. RESULTS--The incidence of anal cancer remained fairly constant in the period 1943-57 and was similar for men and women, but it increased 1.5-fold among men and nearly tripled among women thereafter. Among men the incidence increased from 0.25 per 100,000 population (world standardised) in 1958-62 to 0.38 in 1983-7 (p = 0.01) and among women from 0.28 to 0.74 (p < 0.01). The greatest increase was among residents of the capital (Copenhagen). During 1943-87 age specific trends increased in young and middle aged men and in all age groups among women. Men with anal cancer were significantly more likely throughout the study period to be unmarried than were patients with cancer of the colon (adjusted odds ratio 2.7; 95% confidence interval 2.0 to 3.6) and stomach (2.1; 1.5 to 2.8), but no association with marital status was found among women. CONCLUSIONS--The distribution and incidence of anal cancer have changed appreciably since around 1960, especially among women, which indicates important aetiological changes. Changes in sexual behaviour may have facilitated the spread of a transmittable agent of aetiological importance. It has recently been suggested that cigarette smoking promotes anal cancer, and this finds indirect support in the synchronism between changes in anal cancer incidence and heavy smoking behaviour. Factors associated with homosexuality are likely to explain some of the cases among men.

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Selected References

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  • Peters RK, Mack TM. Patterns of anal carcinoma by gender and marital status in Los Angeles County. Br J Cancer. 1983 Nov;48(5):629–636. [PMC free article] [PubMed]
  • Wexner SD, Milsom JW, Dailey TH. The demographics of anal cancers are changing. Identification of a high-risk population. Dis Colon Rectum. 1987 Dec;30(12):942–946. [PubMed]
  • Biggar RJ, Burnett W, Mikl J, Nasca P. Cancer among New York men at risk of acquired immunodeficiency syndrome. Int J Cancer. 1989 Jun 15;43(6):979–985. [PubMed]
  • Austin DF. Etiological clues from descriptive epidemiology: squamous carcinoma of the rectum or anus. Natl Cancer Inst Monogr. 1982;62:89–90. [PubMed]
  • Daling JR, Weiss NS, Klopfenstein LL, Cochran LE, Chow WH, Daifuku R. Correlates of homosexual behavior and the incidence of anal cancer. JAMA. 1982 Apr 9;247(14):1988–1990. [PubMed]
  • Mahaney FX., Jr Fighting cancer with cigarette taxes. J Natl Cancer Inst. 1989 May 10;81(10):726–728. [PubMed]
  • Holmes F, Borek D, Owen-Kummer M, Hassanein R, Fishback J, Behbehani A, Baker A, Holmes G. Anal cancer in women. Gastroenterology. 1988 Jul;95(1):107–111. [PubMed]
  • Daling JR, Sherman KJ, Hislop TG, Maden C, Mandelson MT, Beckmann AM, Weiss NS. Cigarette smoking and the risk of anogenital cancer. Am J Epidemiol. 1992 Jan 15;135(2):180–189. [PubMed]
  • Daling JR, Weiss NS, Hislop TG, Maden C, Coates RJ, Sherman KJ, Ashley RL, Beagrie M, Ryan JA, Corey L. Sexual practices, sexually transmitted diseases, and the incidence of anal cancer. N Engl J Med. 1987 Oct 15;317(16):973–977. [PubMed]
  • Melbye M, Sprøgel P. Aetiological parallel between anal cancer and cervical cancer. Lancet. 1991 Sep 14;338(8768):657–659. [PubMed]
  • zur Hausen H. Papillomaviruses in anogenital cancer as a model to understand the role of viruses in human cancers. Cancer Res. 1989 Sep 1;49(17):4677–4681. [PubMed]
  • Blohmé I, Brynger H. Malignant disease in renal transplant patients. Transplantation. 1985 Jan;39(1):23–25. [PubMed]
  • Beckmann AM, Daling JR, Sherman KJ, Maden C, Miller BA, Coates RJ, Kiviat NB, Myerson D, Weiss NS, Hislop TG, et al. Human papillomavirus infection and anal cancer. Int J Cancer. 1989 Jun 15;43(6):1042–1049. [PubMed]
  • Melbye M, Palefsky J, Gonzales J, Ryder LP, Nielsen H, Bergmann O, Pindborg J, Biggar RJ. Immune status as a determinant of human papillomavirus detection and its association with anal epithelial abnormalities. Int J Cancer. 1990 Aug 15;46(2):203–206. [PubMed]
  • Caussy D, Goedert JJ, Palefsky J, Gonzales J, Rabkin CS, DiGioia RA, Sanchez WC, Grossman RJ, Colclough G, Wiktor SZ, et al. Interaction of human immunodeficiency and papilloma viruses: association with anal epithelial abnormality in homosexual men. Int J Cancer. 1990 Aug 15;46(2):214–219. [PubMed]
  • Goldman S, Glimelius B, Nilsson B, Påhlman L. Incidence of anal epidermoid carcinoma in Sweden 1970-1984. Acta Chir Scand. 1989 Mar;155(3):191–197. [PubMed]
  • Melbye M, Biggar RJ. Interactions between persons at risk for AIDS and the general population in Denmark. Am J Epidemiol. 1992 Mar 15;135(6):593–602. [PubMed]
  • Scholefield JH, Thornton Jones H, Cuzick J, Northover JM. Anal cancer and marital status. Br J Cancer. 1990 Aug;62(2):286–288. [PMC free article] [PubMed]
  • Osler M. Smoking habits in Denmark from 1953 to 1991: a comparative analysis of results from three nationwide health surveys among adult Danes in 1953-1954, 1986-1987 and 1990-1991. Int J Epidemiol. 1992 Oct;21(5):862–871. [PubMed]
  • Melbye M, Biggar RJ, Ebbesen P, Sarngadharan MG, Weiss SH, Gallo RC, Blattner WA. Seroepidemiology of HTLV-III antibody in Danish homosexual men: prevalence, transmission, and disease outcome. Br Med J (Clin Res Ed) 1984 Sep 8;289(6445):573–575. [PMC free article] [PubMed]
  • Palefsky JM, Holly EA, Gonzales J, Berline J, Ahn DK, Greenspan JS. Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res. 1991 Feb 1;51(3):1014–1019. [PubMed]

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