Approximately 8,200 new cases (2,950 males; 5,250 females) of anal carcinoma will be diagnosed in the United States in 2017. Specifically, anal squamous cell carcinoma accounts for about 70% of all anal cancers in the US and is associated with human papillomavirus (HPV) and human immunodeficiency virus (HIV) infections. As cancer prevention and treatments have evolved over time, medical management of HIV has improved, and sexual behaviors have changed, anal carcinoma incidence rates may have also changed. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify and determine incidence rates for 6,607 men and 5,729 women diagnosed with anal cancer from 1973-2013. Carcinoma in situ (CIS) and invasive disease (SCC), as defined by the SEER historical stage category, were analyzed separately. Joinpoint regression models identified time points at which histology-specific incidence trends changed. Age-adjusted incidence rate changes over time are expressed as annual percent changes (APC), which represent the log-transformed slopes across time. Joinpoint regression was performed using the Joinpoint software program (v4.3.1.0) and all other analyses were performed using SEER*Stat software (v8.3.2) and Stata/SE (v13.1). Results: Joinpoint analyses identified 1994 and 2011 as the inflection points at which combined anal CIS and SCC average annual incidence rates shifted most markedly among 12,336 patients from 1973-2013. The slope of incidence rates recently decreased (2011, 95% CI 2008-2011; APC -4.92, 95% CI -16.8 to 8.6). Separate joinpoint analyses were conducted for noninvasive disease (CIS) and invasive cancer (SCC). Although men and women were more likely to present with CIS (risk ratio [RR] 1.51, 95% CI 1.45-1.59) after 2011, the slope of incidence rates for CIS have statistically decreased (2010, 95% CI 2008-2011; APC -6.96, 95% CI -13.3 to -0.2), especially for men (2010, 95% CI 2007-2011, APC -9.25, 95% CI -16.0 to -1.9). Moreover, both men and women were less likely to present with localized (RR 0.81, 95% CI 0.76-0.87), regional (RR 0.69, 95% CI 0.63-0.76), and distant SCC (RR 0.89, 95% CI 0.75-1.06). During 2011-2013, men were more likely to present with CIS (RR 2.58, 95% CI 2.34-2.86) but less likely to present with localized (RR 0.46, 95% CI 0.41 - 0.53), regional (RR 0.41, 95% CI 0.34 - 0.49), and distant SCC (RR 0.37, 95% CI 0.26 - 0.51) compared to women. The later time period also included younger age at diagnosis. Anal cancer incidence rates have decreased since 2011. Moreover, patients are more likely to present with CIS than invasive disease at any stage, and this trend is more pronounced in men. These changes in anal carcinoma patterns may reflect improved HIV management, increased use of barrier protection for men, and efficacious screening and management of anal squamous intraepithelial lesions.