Evaluation of anal cytology and human papillomavirus infection in high-risk women: a cross-sectional study
DOI:
https://doi.org/10.13181/mji.oa.236375Keywords:
anal neoplasms, cytology, human papillomavirus, Papanicolaou test, uterine cervical neoplasmsAbstract
BACKGROUND Anal cancer incidence has been on the rise over the past few decades. This study aimed to assess anal Papanicolaou (Pap) smear changes in women with high risk for dysplasia and human papillomavirus (HPV) infection.
METHODS This cross-sectional study was conducted on 121 patients referred to the Gynecology Oncology Clinic of Imam Hossein Medical Center between 2020 and 2021 in Tehran, Iran, who had cervical and vulvar dysplasia, cervical HPV infection, and abnormal cervical cytology results and were over 21 years old. Data analysis was performed using SPSS software version 21 (IBM Corp., USA) at a significance level of 0.05.
RESULTS 121 women, with a mean age of 39.69 years, were included in this study. Overall, 23.1% of women had positive anal HPV results, and 35.5% were over 40 years old. Younger age was associated with an increased risk of anal HPV (p = 0.045). 33.9% of women were single and had a higher risk of anal HPV. Multiple sexual partnerships and anal sex were the significant risk factors for anal cancer (p<0.001). Women with positive anal HPV results had significantly more genital warts (p<0.001). No significant difference was observed in smoking, educational level, and cervical Pap smear results between women with negative and positive rectal HPV results.
CONCLUSIONS Younger age at diagnosis, being single, having multiple sexual partnerships, having anal sex, and having genital warts were associated with anal HPV infection in women. Abnormal anal cytology was only associated with being single and having multiple sexual partners.
Downloads
References
Saleem AM, Paulus JK, Shapter AP, Baxter NN, Roberts PL, Ricciardi R. Risk of anal cancer in a cohort with human papillomavirus-related gynecologic neoplasm. Obstet Gynecol. 2011;117(3):643-9. https://doi.org/10.1097/AOG.0b013e31820bfb16
National Cancer Institute. Cancer Stat Facts: Anal Cancer [Internet]. National Cancer Institute; 2022 [cited 2022 Oct 20]. Available from: https://seer.cancer.gov/statfacts/html/anus.html.
Stier EA, Chiao EY. Anal cancer and anal cancer precursors in women with a history of HPV-related dysplasia and cancer. Semin Colon Rectal Surg. 2017;28(2):97-101. https://doi.org/10.1053/j.scrs.2017.04.008
van Eer K, Laâbi I, van Benthem BH, Steenbergen RDM, King AJ, Medical Microbiological Laboratories and the Public Health Services: Medical Microbiological Laboratories: Certe; et al. The association between viral load and concurrent human papillomavirus infection at the genital and anal sites of young women and the impact of vaccination. Tumour Virus Res. 2022; 13:200233. https://doi.org/10.1016/j.tvr.2021.200233
Aguiar C, García L, Boccardo MB, Vassel M, Arriola A, Jaumandreu S, et al. Anal PAP, HPV tests and magnifying chromoendoscopy with biopsies in the diagnosis of anal intraephitelial neoplasia. J Coloproctology. 2020;40(3):220-6. https://doi.org/10.1016/j.jcol.2020.05.003
Krzowska-Firych J, Lucas G, Lucas C, Lucas N, Pietrzyk ?. An overview of human papillomavirus (HPV) as an etiological factor of the anal cancer. J Infect Public Health. 2019;12(1):1-6. https://doi.org/10.1016/j.jiph.2018.06.005
Tatti S, Suzuki V, Fleider L, Maldonado V, Caruso R, Tinnirello Mde L. Anal intraepithelial lesions in women with human papillomavirus-related disease. J Low Genit Tract Dis. 2012;16(4):454-9. https://doi.org/10.1097/LGT.0b013e31825d2d7a
Hosseini MS, Khosravi D, Farzaneh F, Ebrahimi A, Arab M, Ashraf Ganjoie T, et al. Evaluation of anal cytology in women with history of abnormal pap smear, cervical intraepithelial neoplasia, cervical cancer and high risk hpv for anogenital dysplasia. Asian Pac J Cancer Prev. 2018;19(11):3071-5. https://doi.org/10.31557/APJCP.2018.19.11.3071
Lin C, Slama J, Gonzalez P, Goodman MT, Xia N, Kreimer AR, et al. Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis. Lancet Infect Dis. 2019;19(8):880-91. https://doi.org/10.1016/S1473-3099(19)30164-1
Inthasorn P, Wetpithayakom N, Laiwejpithaya S, Lohsiriwat V, Jaishuen A, Viriyapak B. Prevalence of abnormal anal cytology in women with abnormal cervical cytology. Asian Pac J Cancer Prev. 2021;22(7):2165-9. https://doi.org/10.31557/APJCP.2021.22.7.2165
Lin C, Franceschi S, Clifford GM. Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: a systematic review and meta-analysis. Lancet Infect Dis. 2018;18(2):198-206. https://doi.org/10.1016/S1473-3099(17)30653-9
Moscicki AB, Darragh TM, Berry-Lawhorn JM, Roberts JM, Khan MJ, Boardman LA, et al. Screening for anal cancer in women. J Low Genit Tract Dis. 2015;19(3 Suppl 1):S27-42. https://doi.org/10.1097/LGT.0000000000000117
van der Zee RP, Richel O, de Vries HJ, Prins JM. The increasing incidence of anal cancer: can it be explained by trends in risk groups? Neth J Med. 2013;71(8):401-11.
Calore EE, Giaccio CM, Nadal SR. Prevalence of anal cytological abnormalities in women with positive cervical cytology. Diagn Cytopathol. 2011;39(5):323-7. https://doi.org/10.1002/dc.21386
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.