SEXUAL PRACTICES, SEXUALLY-TRANSMITTED DISEASES, AND THE INCIDENCE OF ANAL CANCER
SEXUAL PRACTICES, SEXUALLY-TRANSMITTED DISEASES, AND THE INCIDENCE OF ANAL CANCER
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DOI：
10.1056/nejm198710153171601
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发表时间：
1987-10-15
影响因子：
158.5
通讯作者：
COREY, L
中科院分区：
文献类型：
--
作者：
DALING, JR;WEISS, NS;COREY, L
为了阐明肛门癌的危险因素，我们采访了148名肛门癌患者和166名结肠癌对照者，并在1978年至1985年期间诊断出这些疾病。我们发现，在男性中，接受性肛交史（与同性恋行为有关）与肛门癌的发生密切相关（相对风险，33。1; 95%置信区间，4.0至272.1）。肛交与女性肛门癌的风险仅弱相关（相对风险为1.8; 95%置信区间为0.7至4.2）。在鳞状细胞肛门癌患者中，47.1%的同性恋男性、28.6%的异性恋男性和28.3%的女性有生殖器疣病史，而对照组中只有1%~ 2%的人有生殖器疣病史，没有移行细胞肛门癌患者。在没有疣病史的患者中，肛门癌与异性恋男性的淋病病史有关（相对危险度，17.2; 95%置信区间，2.0至149.4）和单纯疱疹2型血清阳性（相对危险度，4.1; 95%置信区间，1.9至8.8）和沙眼衣原体（相对危险度，2.3; 95%置信区间，1.1至4.8）。目前吸烟对于女性（相对风险，7.7; 95%置信区间，3.5至17.2）和男性（相对风险，9.4; 95%置信区间，2.3至38.5）来说都是一个重要的危险因素。我们的结论是，男性的同性恋行为是肛门癌的一个危险因素，鳞状细胞肛门癌也与生殖器疣的历史，一个协会表明，乳头瘤病毒感染是肛门癌的原因。某些其他生殖器感染和吸烟也与肛门癌有关。
To elucidate the risk factors for anal cancer, we interviewed and obtained blood specimens from 148 persons with anal cancer and from 166 controls with colon cancer in whom these diseases were diagnosed during 1978-1985. We found that in men, a history of receptive anal intercourse (related to homosexual behavior) was strongly associated with the occurrence of anal cancer (relative risk, 33. 1; 95 percent confidence interval, 4.0 to 272.1). Anal intercourse was only weakly associated with the risk of anal cancer in women (relative risk, 1.8; 95 percent confidence interval, 0.7 to 4.2). Among the subjects with squamous-cell anal cancer, 47.1 percent of homosexual men, 28.6 percent of heterosexual men, and 28.3 percent of women gave a history of genital warts, as compared with only 1 to 2 percent of controls and no patients with transitional-cell anal cancer. In patients without a history of warts, anal cancer was associated with a history of gonorrhea in heterosexual men (relative risk, 17.2; 95 percent confidence interval, 2.0 to 149.4) and with seropositivity for herpes simplex type 2 (relative risk, 4.1; 95 percent confidence interval, 1.9 to 8.8) and Chlamydia trachomatis (relative risk, 2.3; 95 percent confidence interval, 1.1 to 4.8) in women. Current cigarette smoking was a substantial risk factor in both women (relative risk, 7.7; 95 percent confidence interval, 3.5 to 17.2) and men (relative risk, 9.4; 95 percent confidence interval, 2.3 to 38.5). We conclude that homosexual behavior in men is a risk factor for anal cancer, and that squamous-cell anal cancer is also associated with a history of genital warts, an association suggesting that papillomavirus infection is a cause of anal cancer. Certain other genital infections and cigarette smoking are also associated with anal cancer.