This Article


Creative Commons License
Except where otherwise noted, this work is licensed under Creative Commons Attribution-NonCommercial 4.0 International License.

Risk Factors for Anal Cancer

1 Coloproktologisches Center (CPZ) Düsseldorf, Düsseldorf, Germany
*Corresponding author: Faramarz Pakravan, Coloproktologisches Center (CPZ) Düsseldorf, Düsseldorf, Germany. Tel: +49-211393366, Fax: +49-2113005401, E-mail:
Annals of Colorectal Research. 2014 September; 2(3): e21533 , DOI: 10.17795/acr-21533
Article Type: Letter; Received: Jun 25, 2014; Accepted: Jun 26, 2014; epub: Sep 30, 2014; ppub: Sep 1, 2014

Keywords: Anal; Cancer; HIV; Infection; Human; Papilloma; Virus

Dear Editor,

We thank Shapour Omidvari and Mansour Ansari et al. for the article entitled “Malignant Neoplasms of the Anal Canal", which was published in Annals of Colorectal Research (2013). We read the article with interest and the knowledge that presenting retrospective data would be often difficult. Due to many patient-based data, it might be helpful to use structured tables for better clarity in next reports. The results of the study were in agreement with the literature. We completely agree with the authors that the most important prognostic factors are still the histopathologic type of the tumor and the stage of the disease. To our knowledge, some important facts regarding the pathogenesis and etiology of anal neoplasms were missed in that article. The authors only briefly mentioned that human papilloma virus (HPV) and human immunodeficiency virus (HIV) infections are risk factors for anal cancer. Nowadays, we see an increasing incidence of malignant anal neoplasms. Additionally, the rate of new HIV infections has raised during recent years, especially in males. Generally, over 90% of all men who have sex with men (MSM) are infected with HPV. Recently published studies have shown that HPV and HIV infections are the most important risk factors for development of anal cancer. We have to deal with a new group of patients with a compromised immune system (1, 2). Lately, Fraunholz et al. confirmed that in days of highly active antiretroviral therapy, anal cancer could be treated with standard radiochemotherapy (3).


Authors’ Contributions: Both authors participated in interpretation, analysis, and writing the letter.


  • 1. Simpson JA, Scholefield JH. Diagnosis and management of anal intraepithelial neoplasia and anal cancer. BMJ. 2011;343:d6818. [DOI] [PubMed]
  • 2. Wexler A, Goldstone SE, et al. . Invasive anal squamous-cell carcinoma in the HIV-positive patient:outcome in the era of highly active retroviral therapy. Dis Colon Rectum Mar. 2014;57(3):316-23.
  • 3. Fraunholz IB, Haberl A, Klauke S, Gute P, Rodel CM. Long-term effects of chemoradiotherapy for anal cancer in patients with HIV infection: oncological outcomes, immunological status, and the clinical course of the HIV disease. Dis Colon Rectum. 2014;57(4):423-31. [DOI] [PubMed]