{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:25:20Z","timestamp":1791257120635,"version":"4.1.0"},"reference-count":45,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"6","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2023,2,20]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Squamous cell carcinoma of the anus (SCCA) incidence and mortality rates are rising in the United States. Understanding state-level incidence and mortality patterns and associations with smoking and AIDS prevalence (key risk factors) could help unravel disparities and provide etiologic clues. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> Using the US Cancer Statistics and the National Center for Health Statistics data sets, we estimated state-level SCCA incidence and mortality rates. Rate ratios (RRs) were calculated to compare incidence and mortality in 2014-2018 versus 2001-2005. The correlations between SCCA incidence with current smoking (from the Behavioral Risk Factor Surveillance System) and AIDS (from the HIV Surveillance system) prevalence were evaluated using Spearman's rank correlation coefficient. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> Nationally, SCCA incidence and mortality rates (per 100,000) increased among men (incidence, 2.29-3.36, mortality, 0.46-0.74) and women (incidence, 3.88-6.30, mortality, 0.65-1.02) age \u2265 50 years, but decreased among men age &lt; 50 years and were stable among similar-aged women. In state-level analysis, a marked increase in incidence (\u2265 1.5-fold for men and \u2265 two-fold for women) and mortality (\u2265 two-fold) for persons age \u2265 50 years was largely concentrated in the Midwestern and Southeastern states. State-level SCCA incidence rates in recent years (2014-2018) among men were correlated ( r = 0.47, P &lt; .001) with state-level AIDS prevalence patterns. For women, a correlation was observed between state-level SCCA incidence rates and smoking prevalence ( r = 0.49, P &lt; .001). <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> During 2001-2005 to 2014-2018, SCCA incidence and mortality nearly doubled among men and women age \u2265 50 years living in Midwest and Southeast. State variation in AIDS and smoking patterns may explain variation in SCCA incidence. Improved and targeted prevention is needed to combat the rise in SCCA incidence and mitigate magnifying geographic disparities. <\/jats:p><\/jats:sec><jats:sec><jats:title\/><jats:p> [Media: see text] <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.22.01390","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T20:59:21Z","timestamp":1669669161000},"page":"1228-1238","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":53,"title":["State Variation in Squamous Cell Carcinoma of the Anus Incidence and Mortality, and Association With HIV\/AIDS and Smoking in the United States"],"prefix":"10.1200","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4361-4515","authenticated-orcid":true,"given":"Haluk","family":"Damgacioglu","sequence":"first","affiliation":[{"name":"Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9034-7718","authenticated-orcid":true,"given":"Yueh-Yun","family":"Lin","sequence":"additional","affiliation":[{"name":"Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Patricia","family":"Ortiz","sequence":"additional","affiliation":[{"name":"University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Fang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahed","family":"Shahmoradi","sequence":"additional","affiliation":[{"name":"Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiang Shiuan","family":"Shyu","sequence":"additional","affiliation":[{"name":"Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX"},{"name":"Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruosha","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2020-9904","authenticated-orcid":true,"given":"Alan G.","family":"Nyitray","sequence":"additional","affiliation":[{"name":"Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI"},{"name":"Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4051-4861","authenticated-orcid":true,"given":"Keith","family":"Sigel","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Department of Medicine, Mt Sinai Icahn School of Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7534-333X","authenticated-orcid":true,"given":"Gary M.","family":"Clifford","sequence":"additional","affiliation":[{"name":"Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC\/WHO), Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Jay","sequence":"additional","affiliation":[{"name":"Anal Neoplasia Clinic, Research, and Education Center, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian Colon","family":"Lopez","sequence":"additional","affiliation":[{"name":"University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5453-5516","authenticated-orcid":true,"given":"Gregory M.","family":"Barnell","sequence":"additional","affiliation":[{"name":"Kaiser Permanente, Oakland Medical Center, Department of Surgery, Oakland, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5752-2916","authenticated-orcid":true,"given":"Elizabeth Y.","family":"Chiao","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Stier","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Boston Medical Center\/Boston University School of Medicine, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-9947","authenticated-orcid":true,"given":"Karen J.","family":"Ortiz-Ortiz","sequence":"additional","affiliation":[{"name":"University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeslie M.","family":"Ramos-Cartagena","sequence":"additional","affiliation":[{"name":"The University of Puerto Rico\/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyani","family":"Sonawane","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC"},{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8936-8108","authenticated-orcid":true,"given":"Ashish A.","family":"Deshmukh","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC"},{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz219"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1200\/GO.20.00299"},{"key":"b3","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa128"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34269"},{"key":"b5","unstructured":"Vespa J, Armstrong DM, Medina L: Demographic Turning Points for the United States: Population Projections for 2020 to 2060: Population Estimates and Projections. Department of Commerce Economics and Statistics Administration, Washington, DC, US Census Bureau, 2018, pp 25-1144"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33185"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.74.9291"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000808"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20365"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctarc.2021.100503"},{"key":"b11","doi-asserted-by":"publisher","DOI":"10.1158\/1541-7786.MCR-13-0541"},{"key":"b12","doi-asserted-by":"publisher","DOI":"10.2196\/publichealth.5365"},{"key":"b13","volume-title":"HIV Surveillance Report","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"b14","volume-title":"State Tobacco Activities Tracking and Evaluation System: Map of Current Cigarette Use Among Adults","author":"Centers for Disease Control and Prevention","year":"2022"},{"key":"b15","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz831"},{"key":"b16","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002326"},{"key":"b17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2201048"},{"key":"b18","volume-title":"Anal Cancer: Early Detection, Diagnosis, and Staging; Screening in People at High Risk","author":"American Cancer Society","year":"2017"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit757"},{"key":"b20","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001114"},{"key":"b21","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac103"},{"key":"b22","volume-title":"National Program of Cancer Registries and Surveillance Epidemiology and End Results SEER*Stat Database: NPCR and SEER Incidence: US Cancer Statistics Public Use Research Database, 2020 submission (2001-2018)"},{"key":"b23","volume-title":"International Classification of Diseases for Oncology","author":"World Health Organization","year":"2000","edition":"3"},{"key":"b24","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3733"},{"key":"b25","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30434-5"},{"key":"b26","unstructured":"Centers for Disease Control and Prevention: HIV in the Southern United States. Division of HIV\/AIDS Prevention, National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention, 2019"},{"key":"b27","unstructured":"US Food and Drug Administration: FDA approves first injectable treatment for HIV pre-exposure prevention. US Department of Health and Human Services, 2001"},{"key":"b28","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/91.8.708"},{"key":"b29","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkac004"},{"key":"b30","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-21-1373"},{"key":"b31","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33178"},{"key":"b32","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djs371"},{"key":"b33","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30164-1"},{"key":"b34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.1999"},{"key":"b35","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34199"},{"key":"b36","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000508"},{"key":"b37","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02566"},{"key":"b38","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30139-0"},{"key":"b39","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.24502"},{"key":"b40","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-026286"},{"key":"b41","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2022.107218"},{"key":"b42","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2018.1553475"},{"key":"b43","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002815"},{"key":"b44","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30170-5"},{"key":"b45","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07755-3"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.22.01390","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T15:55:34Z","timestamp":1677254134000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.22.01390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,20]]},"references-count":45,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,2,20]]}},"alternative-id":["10.1200\/JCO.22.01390"],"URL":"https:\/\/doi.org\/10.1200\/jco.22.01390","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,20]]},"assertion":[{"value":"2022-06-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-04","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}