EP570 - Disparities in Diagnosis and Treatment of Anal Squamous Cell Cancer

Purpose/Background: Anal squamous cell carcinoma is a rare but highly treatable malignancy with a rising global incidence. Delays in diagnosis are common, which can often be due to an initial misdiagnosis or lack of a thorough anorectal exam. Previous studies have shown that over half of anal cancer patients were misdiagnosed, with up to 27% of patients initially misdiagnosed with hemorrhoids. These delays can lead to an advanced stage at diagnosis with decreased survival. We aim to capture a comprehensive snapshot of the patient population most affected by anal cancer, quantify symptom onset to diagnosis and identify factors contributing to delays in diagnosis, including health care disparities and referral and evaluation by a colorectal surgeon.

Methods/Interventions: We conducted a retrospective observational cohort study of patients diagnosed with anal squamous cell carcinoma at our institution. Inclusion criteria encompassed all adult patients with biopsy-proven anal squamous cell carcinoma from 2016-2023. We identified demographic variables (age, sex, race/ethnicity, insurance status), clinical risk factors (HIV/AIDS, immunosuppression, history of transplant, chemotherapy exposure), as well as dates of symptom onset, first anorectal exam, referrals, and treatments. Our primary outcome is the interval from symptom onset to diagnosis, with secondary outcomes including symptom onset to provider exams, demographics, treatment outcomes, and mortality rates.

Results/Outcomes: A total of 118 patients were included. Of those, 86 (72.9%) had no delay in diagnosis, and 32 (27.1%) experienced a delay, defined as greater than 90 days from reporting symptoms to a provider to diagnosis. Patients in the delay group were younger, with a median age of 59 versus 64 years (p=0.026). A history of anal dysplasia was also associated with a delay in diagnosis (8 vs 6, p< 0.001). The median time from symptom report to diagnosis was 28 days in the no-delay group compared with 164 days in the delay group (p < 0.001) and patients with a delay in diagnosis took an average of 119 days to see a colorectal surgeon from time of first reporting symptoms versus 18 days in the no-delay group (p <.001). Patients with a delayed diagnosis were more often initially managed with topical therapy. The stage at diagnosis did not differ by delay status, but we did find that patients with commercial insurance more often presented at stage I/II, compared with Medicaid or self-pay patients who presented at stage III/IV. Rates of treatment completion and overall 5-year survival were similar between both groups.

Conclusion/Discussion: Delays in management of anal squamous cell carcinoma were common, and strongly associated with prolonged time to initial exam, referral, and ultimately diagnosis. Younger age and a history of anal dysplasia were associated with increased likelihood of delay, while insurance status influenced stage at presentation. While survival outcomes were similar in both groups, these findings highlight opportunities for earlier recognition, improvements in streamlining referrals for these patients, and increasing access to specialist evaluations to reduce diagnostic delays.