EPD502 - Temporality and Risk Factors Associated with Multi-site Anogenital Squamous Dysplasia/Cancer

ePoster of Distinction Presenter(s)

• JZ

  Joy Zhang, MD

  General Surgery Resident
  The Ohio State University Wexner Medical Center - Columbus, OH
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  JC Chen, MD MPH (they/them/theirs)

  Resident
  Ohio State University
  Ohio State University
  Columbus, OH, United States

  Disclosure information not submitted.
• 

  Michelle Chan, MD (she/her/hers)

  General surgery resident
  The Ohio State University
  The Ohio State University
  Columbus, OH, United States

  Disclosure information not submitted.
• 

  Nikita Wadhwani, MD (she/her/hers)

  Colon and rectal surgery fellow
  The Ohio State University
  University of Alabama at Birmingham
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• SB

  Sydney C. Beache, MD, MPHS (she/her/hers)

  Fellow
  The Ohio State University
  The Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AH

  Alan E. Harzman, MD

  Professor
  The Ohio State University
  Columbus, Ohio, United States

  Disclosure information not submitted.
• 

  Lisa A. Cunningham, MD

  Assistant Professor
  The Ohio State University
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AG

  Alessandra Gasior, DO

  Associate Professor
  The Ohio State University
  Columbus, Ohio, United States

  Disclosure information not submitted.
• 

  Amber L. Traugott, MD (she/her/hers)

  Associate Professor
  The Ohio State University
  The Ohio State University Wexner Medical Center
  Columbus, Ohio, United States

  Disclosure information not submitted.
• 

  Emily Huang, MD, MEd

  Associate Professor
  The Ohio State University
  Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• 

  Syed Husain, MB.,BS.

  Professor of Surgery-Clinical
  The Ohio State University
  Ohio State University
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Women with lower genital (i.e., cervical, vulvar, and vaginal) dysplasia and cancer have increased incidence of anal dysplasia. Multiple risk factors, including high-risk human papillomavirus (HRHPV) and immunosuppression, influence prevalence and severity of lower genital and anorectal dysplasia. However, temporal association between and factors associated with the development of lower genital and anorectal dysplasia remain unclear. Understanding this association is critical for the coordination of multidisciplinary care for lower genital and anorectal disease.

The objectives of this study are to 1) characterize the temporal sequence between and 2) explore risk factors associated with the development of multi-site lower genital and anorectal dysplasia.

Methods/Interventions: Patients assigned female at birth ≥18 years diagnosed with anal dysplasia and/or cancer at a comprehensive cancer center between 2017-2024 were retrospectively reviewed. Variables collected included demographics, behavioral/clinical factors (smoking, immunosuppression, HIV status), HRHPV status, HPV vaccination status, date of diagnosis and severity of any lower genital and anorectal dysplasia/cancer. Cumulative hazard plots were used to determine the median time to development of dysplasia at another lower genital or anorectal site distinct from the index lesion (ie, development of anorectal dysplasia after diagnosis of cervical cancer). The influence of index dysplasia grade on subsequent distinct lesion severity was evaluated using Kruskal-Wallis tests. Associations between risk factors and the development of additional distinct dysplasia sites were explored using multivariable Cox proportional hazards regression.

Results/Outcomes: Among 446 women, 120 (26.8%) experienced dysplasia or cancer at both lower genital and anorectal sites. Among the cohort, 62 (51.6%) women had cervical dysplasia/cancer diagnoses prior to anorectal dysplasia/cancer, while four (3.0%) were diagnosed afterward. Vulvar dysplasia/cancer preceded anorectal diagnoses in 51 (42.5%) women and followed in 15 (12.5%). One patient (0.8%) had concurrent cervical and anorectal diagnoses, and five (4.2%) had concurrent vulvar, dysplasia/cancer at the time of anorectal diagnosis. Median time to development of dysplasia at a second distinct site was 34.8 months. There was no association between degree of dysplasia at the index site and degree of severity at subsequent sites (p=0.33). Each additional year in age decreased risk of developing dysplasia at another site by 4% (HR 0.96, 95% CI 0.95-0.98), which remained significant on multivariable analysis. Neither degree of immunosuppression, HIV, HRHPV, nor HPV vaccination status were associated with the development of dysplasia at an additional site (all p>0.05).

Conclusion/Discussion: More than a quarter of women with anal dysplasia/cancer exhibited lower genital dysplasia or cancer within 3 years immediately preceding or after their diagnosis. Our findings suggest a strong temporal association between lower genital and anorectal dysplasia/cancer. This study highlights the need to emphasize and broaden anal cancer screening to comprehensively screen and treat patients with lower genital dysplasia/cancer.

Temporal Relationship of Lower Genital Dysplasia/Cancer Diagnosis Relative to Anorectal Dysplasia/Cancer Diagnosis
Temporal patterns of lower genital dysplasia/cancer relative to anorectal dysplasia/cancer based on diagnosis date. The dashed line indicates the time of anorectal diagnosis. Negative values denote lower genital diagnoses preceding and positive values denote diagnoses following.