The long journey of patients with anal carcinoma in a Mexican cohort.

Abstract

e15504 Background: Yearly 1000 new cases of anal cancer will be diagnosed in the USA, in Mexico this information is limited. Increasing incidence is the reflection of improvements in knowledge of risk factors and diagnostic studies. Female sex, HPV infection, genital warts, number of sexual partners, receptive anal intercourse, smoking and HIV infection are well established risk factors. Methods: We performed a retrospective analysis of patients with pathology-confirmed anal carcinoma treated at an Oncology Reference Center in North-East Mexico from 2010 to 2020. Using the digital database of our center we searched the time passed since debut of symptoms to first medical contact, date of biopsy and first oncology consultation. Results: 81 patients were found in the database from January 2010 to December 2020. Forty-one patients were included in the final analysis, 11 patients where reassessed as rectal cancer and 29 patients only attended one consultation and did not continue follow up. Mean age at diagnosis was 61.4 +/- 13.8 years and 58.5% were women. 69% of patients had an education degree lower than highschool. HIV status was known only in 9.8% as they were living with HIV before the diagnosis of anal cancer was made, contrasting from 63.4% of cases who had unknown status at cancer diagnosis. The time from symptom onset until the patient attended a healthcare provider was a mean of 7.6 months (5 – 1000 days) and 11.4 months (9-1435 days) to receive a diagnosis. Patients had an average delay of 80 days from biopsy result to be evaluated by an oncologist. 44% of patients were initially misdiagnosed as hemorrhoids. None of the female patients had history of recent Pap smear test. 65% of patients had nodal involvement at presentation. Conclusions: There is notable delay between the onset of symptoms and diagnosis of anal cancer. This information is crucial for the general population and all healthcare providers not only oncology related workers. The stigma as well as the cultural barriers associated with this disease may negatively impact the prognosis and quality of life by delaying promptly treatment. Although it is a rare disease, conducting educational campaigns with the intention of improving clinical suspicion and an early recognition may shorten the long journey of patients bearing with anal carcinoma.