{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:50:11Z","timestamp":1787795411916,"version":"build-2784847793"},"reference-count":33,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T00:00:00Z","timestamp":1655424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation of Korea (NRF)","award":["No. 2021R1G1A1010954"],"award-info":[{"award-number":["No. 2021R1G1A1010954"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Purpose: The purpose of our study was to evaluate the relationship between benign anal inflammatory diseases and anorectal cancer and assess its risk factors. Methods: A retrospective matched cohort study was conducted that included data from 2002 to 2013. The National Health Insurance Service National Sample Cohort data from 2002 to 2013 was used for the study. Of a total study population of 143,884 individuals, 28,110 individuals with anal fissures were assigned to the case group, while 115,774 individuals without anal fissures were assigned to the control group based on the 1:4 propensity score matching age, sex, and year (case: diagnosed year, control: health service received year). Results: The risk of anorectal cancer was higher in the case group (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.51\u20132.53) compared to the control group. After grouping anorectal cancers into anal cancer and rectal cancer, the risk remained higher in the case group (anal cancer HR: 2.79, 95% CI: 1.48\u20135.27; rectal cancer HR: 1.82, 95% CI; 1.37\u20132.42). The case group was further categorized into patients with fissures and patients with fistulas; patients with fissures showed a higher risk of developing anorectal cancer than patients with fistulas (HR: 2.05, 95% CI: 1.53\u20132.73 vs. HR: 1.73, 95% CI: 1.13\u20132.66). Study participants in their 30s and 40s had a 4.19- and 7.39-times higher risk of anorectal cancer compared to those in the higher age groups (0.64\u20131.84), while patients who did not have inflammatory bowel disease (IBD) had a higher risk of developing anorectal cancer (HR: 2.09, 95% CI: 1.56\u20132.80). Conclusions and Relevance: Patients with anal fistulas or fissures have an increased risk of being diagnosed with anorectal cancer, especially at a young age and even without IBD.<\/jats:p>","DOI":"10.3390\/ijerph19127467","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T11:45:44Z","timestamp":1655466344000},"page":"7467","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk of Anorectal Cancer Associated with Benign Anal Inflammatory Diseases: A Retrospective Matched Cohort Study"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3241-561X","authenticated-orcid":false,"given":"Wonjeong","family":"Chae","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea"},{"name":"Institute of Health Services Research, Yonsei University, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Yeon","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery, Severance Hospital, College of Medicine, Yonsei University, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-2878","authenticated-orcid":false,"given":"Sung-In","family":"Jang","sequence":"additional","affiliation":[{"name":"Institute of Health Services Research, Yonsei University, Seoul 03722, Korea"},{"name":"Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2136-3578","authenticated-orcid":false,"given":"Yoon Dae","family":"Han","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery, Severance Hospital, College of Medicine, Yonsei University, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,17]]},"reference":[{"key":"ref_1","unstructured":"National Cancer Institute (2021, December 08). Surveillance, Epidemiology, and End Results Program. Anal Cancer, Available online: https:\/\/seer.cancer.gov\/statfacts\/html\/anus.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3393\/ac.2019.07.17","article-title":"Long-term Oncologic Outcome and Its Relevant Factors in Anal Cancer in Korea: A Nationwide Data Analysis","volume":"36","author":"Hur","year":"2020","journal-title":"Ann. Coloproctol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"212","DOI":"10.3393\/ac.2018.08.02.1","article-title":"Characteristics and Survival of Korean Patients with Colorectal Cancer Based on Data from the Korea Central Cancer Registry Data","volume":"34","author":"Hur","year":"2018","journal-title":"Ann. Coloproctol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.12998\/wjcc.v7.i14.1795","article-title":"Prevalence of anal fistula in the United Kingdom","volume":"7","author":"Hokkanen","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4082\/kjfm.2014.35.5.227","article-title":"Factors associated with hemorrhoids in Korean adults: Korean national health and nutrition examination survey","volume":"35","author":"Lee","year":"2014","journal-title":"Korean J. Fam Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1056\/NEJM199408043310504","article-title":"Benign anal lesions and the risk of anal cancer","volume":"331","author":"Frisch","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3390\/medicina45040037","article-title":"Mucinous adenocarcinoma arising in an anorectal fistula","volume":"45","author":"Venclauskas","year":"2009","journal-title":"Medicina"},{"key":"ref_8","first-page":"1798543","article-title":"A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae","volume":"2020","author":"Azmi","year":"2020","journal-title":"Case Rep. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1007\/s00384-009-0657-7","article-title":"Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: A review from single institution","volume":"24","author":"Yang","year":"2009","journal-title":"Int. J. Colorectal. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1136\/gut.2005.070201","article-title":"Elevated anal squamous cell carcinoma risk associated with benign inflammatory anal lesions","volume":"55","author":"Nordenvall","year":"2006","journal-title":"Gut"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1158\/1055-9965.EPI-19-0601","article-title":"Risk of Anal Cancer Following Benign Anal Disease and Anal Cancer Precursor Lesions: A Danish Nationwide Cohort Study","volume":"29","author":"Faber","year":"2020","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1143","DOI":"10.1016\/j.amjmed.2013.05.016","article-title":"The risk of cancer in patients with benign anal lesions: A nationwide population-based study","volume":"126","author":"Lee","year":"2013","journal-title":"Am. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1093\/jnci\/81.22.1726","article-title":"Anal cancer incidence: Genital warts, anal fissure or fistula, hemorrhoids, and smoking","volume":"81","author":"Holly","year":"1989","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1159\/000452869","article-title":"A Case Series of Anal Carcinoma Misdiagnosed as Idiopathic Chronic Anal Fissure","volume":"24","author":"Barbeiro","year":"2017","journal-title":"GE Port. J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2937","DOI":"10.21873\/invivo.12585","article-title":"Relapse of Rectal Cancer in an Anal Fistula: A Rare Case","volume":"35","author":"Kato","year":"2021","journal-title":"In Vivo"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/aam.aam_56_18","article-title":"Inflammation and cancer","volume":"18","author":"Singh","year":"2019","journal-title":"Ann. Afr. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1038\/nature01322","article-title":"Inflammation and cancer","volume":"420","author":"Coussens","year":"2002","journal-title":"Nature"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1038\/435752a","article-title":"Inflammation by remote control","volume":"435","author":"Mantovani","year":"2005","journal-title":"Nature"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"G515","DOI":"10.1152\/ajpgi.00475.2003","article-title":"Inflammation and Cancer II. Role of chronic inflammation and cytokine gene polymorphisms in the pathogenesis of gastrointestinal malignancy","volume":"286","author":"Macarthur","year":"2004","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"G626","DOI":"10.1152\/ajpgi.2001.281.3.G626","article-title":"Nitric oxide in gastrointestinal epithelial cell carcinogenesis: Linking inflammation to oncogenesis","volume":"281","author":"Jaiswal","year":"2001","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1054\/bjoc.2001.1943","article-title":"Chronic immune activation and inflammation as the cause of malignancy","volume":"85","author":"Dalgleish","year":"2001","journal-title":"Br. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1093\/carcin\/bgq176","article-title":"The role of inflammation in HPV carcinogenesis","volume":"31","author":"Boccardo","year":"2010","journal-title":"Carcinogenesis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/PGP.0b013e31826916c7","article-title":"The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: Background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology","volume":"32","author":"Darragh","year":"2013","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Stanley, M.A., Winder, D.M., Sterling, J.C., and Goon, P.K. (2012). HPV infection, anal intra-epithelial neoplasia (AIN) and anal cancer: Current issues. BMC Cancer, 12.","DOI":"10.1186\/1471-2407-12-398"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1038\/sj.bjc.6603175","article-title":"Increasing incidence of squamous cell carcinoma of the anus in Scotland, 1975\u20132002","volume":"95","author":"Brewster","year":"2006","journal-title":"Br. J. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1007\/s10461-015-0997-y","article-title":"Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis","volume":"19","author":"Owen","year":"2015","journal-title":"AIDS Behav."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.1016\/j.vaccine.2011.01.015","article-title":"Trends in anal cancer in Australia, 1982\u20132005","volume":"29","author":"Jin","year":"2011","journal-title":"Vaccine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1002\/ijc.26115","article-title":"Trends in incidence of anal cancer and high-grade anal intraepithelial neoplasia in Denmark, 1978\u20132008","volume":"130","author":"Nielsen","year":"2012","journal-title":"Int. J. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"366","DOI":"10.5534\/wjmh.190137","article-title":"Analysis of Sexual Behaviors among Adults in Korea: Results from the \u201cKorean National Survey on Sexual Consciousness\u201d","volume":"39","author":"Ahn","year":"2021","journal-title":"World J. Mens. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e2019037","DOI":"10.4178\/epih.e2019037","article-title":"Epidemiological characteristics of HIV infected Korean: Korea HIV\/AIDS Cohort Study","volume":"41","author":"Choi","year":"2019","journal-title":"Epidemiol. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1159\/000365309","article-title":"Colorectal Cancer in Inflammatory Bowel Disease: Epidemiology, Pathogenesis and Surveillance","volume":"1","author":"Wang","year":"2014","journal-title":"Gastrointest. Tumors"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1055\/s-0040-1713748","article-title":"Colorectal Cancer in Inflammatory Bowel Disease","volume":"33","author":"Nebbia","year":"2020","journal-title":"Clin. Colon Rectal. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/j.cgh.2017.11.041","article-title":"High Risk of Anal and Rectal Cancer in Patients with Anal and\/or Perianal Crohn's Disease","volume":"16","author":"Beaugerie","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/12\/7467\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:34:20Z","timestamp":1760139260000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/12\/7467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,17]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["ijerph19127467"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19127467","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,17]]}}}