Background: Squamous cell carcinoma of the anus (SCCA) incidence is rising in the United States. Study of incidence trends by stage at diagnosis, age-specific and birth cohort patterns, and trends in mortality could provide evidence for a true increase and etiological clues for the increase in incidence.Methods: Using the US Cancer Statistics dataset, we examined trends in SCCA incidence (2001–2015) and mortality (2001–2016) rates. Join-point regression was used to compute annual and average annual percentage change (AAPC). Incidence patterns by 5-year age group and birth cohort were evaluated using incidence rate ratios (IRRs) and age-period-cohort modeling.Results: SCCA incidence increased 2.7% per year (95% confidence interval [CI] = 2.1% to 3.3%), with pronounced increases in age groups 50 years and older. Distant-stage SCCA incidence tripled (AAPC = 8.6%, 95% CI = 5.4% to 12.0%, among men and AAPC = 7.5%, 95% CI = 4.8% to 10.2%, among women) and regional-stage SCCA incidence nearly doubled (AAPC = 4.7% for men and women) in both sexes; the AAPC for localized stage was 1.3% (95% CI = 0.6% to 2.0%) in men and 2.3% (95% CI = 1.8% to 2.8%) in women. Compared with adults born circa 1946, recently born black men (born circa 1986) had a nearly fivefold higher risk (IRR = 4.7, 95% CI = 2.1 to 10.2) of SCCA, and the risk doubled among white men (IRR = 2.0, 95% CI = 1.7 to 2.2) and white women (IRR = 2.1, 95% CI = 1.9 to 2.3) born after circa 1960. Anal cancer mortality rates increased 3.1% per year (95% CI = 2.6% to 3.5%) with statistically significant increases in age groups 50 years and older. SCCA incidence-based mortality increased 1.9% annually (95% CI = 0.5% to 3.4%), with a notable (4.9%, 95% CI = 2.4% to 7.3%, per year) rise in adults ages 60–69 years.Conclusion: The increase in SCCA incidence, particularly advanced-stage disease, and a similar increase in mortality suggest a true increase in the occurrence of SCCA. Future research and improved prevention are urgently needed to mitigate the increasing disease burden.

Cervical cancer screening has substantially reduced the incidence and mortality of cervical cancer in the US over the past 40 years,¹ and this screening consistently receives an A rating, the highest level of recommendation offered by the US Preventive Services Task Force (USPSTF). Current recommendations suggest that women aged 21 to 29 years with average risk receive cytological screening every 3 years, with screening intervals for those aged 30 to 65 years extended to every 5 years if receiving human papillomavirus (HPV) testing alone or HPV cotesting with cytological screening.² Healthy People 2030 estimated in 2018 that the proportion of women who were up to date on cervical cancer screening was 80.5%, with a target rate of 84.3%.³ However, there is substantial variation in cervical cancer screening rates by race and/or ethnicity, rurality of residence, insurance type, and sexual orientation,⁴ and multiple studies and national reports have reported that the national rate of guideline-concordant screening has been decreasing over the past 5 years.^5-9 Watson et al^5,6 found that this decrease has been more pronounced among younger women (aged 21-29 years), although the factors associated with these changes are unknown.

In the US, breast cancer, cervical cancer, and colorectal cancer could be prevented using the cancer screening schedules recommended by the US Preventive Services Task Force (USPSTF), with the highest level of recommendation (A or B grade).^1-3 These cancer screening recommendations, focusing on the general population at average risk, have been the driving force for the declining population-level incidence and mortality of these cancer types in the US.^4-6 For optimal prevention outcomes at the population level, adequate screening uptake is crucial; however, the screening rates for these 3 cancers are below target rates.^7-9

Human papillomavirus (HPV)-associated anal and oropharyngeal cancer incidence has increased in recent years among US women. However, trends in incidence and burden (annual number of cases) of noncervical HPV-associated cancers relative to cervical cancer remain unclear. Using the 2001-2017 US cancer statistics dataset, we evaluated contemporary incidence trends and burden (annual number of cases) of HPV-associated cancers among women by anatomic site, race or ethnicity, and age. Overall, cervical cancer incidence plateaued among White women but continued to decline among Black and Hispanic women. Anal cancer incidence surpassed cervical cancer incidence among White women aged 65-74 years of age (8.6 and 8.2 per 100 000 in 2015) and 75 years or older (6.2 and 6.0 per 100 000 in 2014). The noncervical cancer burden (n = 11 871) surpassed the cervical cancer burden (n = 11 527) in 2013. Development of efficacious screening strategies for noncervical cancers and continued improvement in cervical cancer prevention are needed to combat HPV-associated cancers among women.

Despite recent improvements in rates of cancer survival, deaths from suicide among people with cancer continue to be higher than the general population in the US.^1-4 Both individual-level sociodemographic (age, sex, economic status, and marital status) and clinical (depression, cancer site, and time since diagnosis) risk factors are associated with suicide among people with cancer.^2,3,5,6 In particular, depression, one of the most common psychiatric complications among people with cancer, has been reported to increase the risk of mortality by nearly 40%.^7-9 Although the determinants of depressive disorders among people diagnosed with cancer are likely multifactorial, some risk factors for suicide may be more prevalent among people with cancer: functional impairment, poorer social and family well-being, and lower socioeconomic status.^8,10 Data also suggest financial insolvency contributes to early mortality among people with cancer. Ramsey et al¹¹ reported that filing bankruptcy was associated with a 79% increase in early mortality among people with cancer. These findings imply that social and economic status may be important factors in understanding the higher rates of suicide among people with cancer.