Anal cancer burden among people with HIV across US states, DC, and major metro areas

Anal cancer screening is recommended for people with HIV in the United States (US). Because HIV prevalence varies geographically, the distribution of anal cancer diagnoses occurring among people with HIV may also differ by geography. Characterizing geographic variation can help identify areas needing enhanced screening infrastructure and outreach.

Using data from the HIV/AIDS Cancer Match Study, US cancer registries, and CDC's National HIV Surveillance System, we estimated the proportion of incident anal squamous cell carcinomas (SCC) among people with HIV across the 50 states, the District of Columbia (DC), and major metropolitan statistical areas (MSAs).

During 2010-2019, an average of 2,160 anal SCC diagnoses occurred annually among males, 414 (20.1%; Uncertainty Interval [UI]=19.4%-20.6%) among males with HIV. Among females, 58 of an average 4,099 annual anal SCC diagnoses (1.4%; UI = 1.3%-1.5%) occurred among females with HIV. Geographic variation among males was substantial. California had the highest annual number of anal SCC diagnoses among males with HIV (70/239; 29.2% [UI = 26.7%-31.8%]), followed by New York (48/161; 29.8% [UI = 26.3%-33.4%]), Florida (42/182; 23.1% [UI = 20.3%-26.1%]), Texas (36/132; 27.0% [UI = 23.7%-30.4%]), and Georgia (20/80; 25.2% [UI = 20.9%-29.8%]). New York had the highest annual number of diagnoses among females with HIV (10/263; 3.7% [UI = 3.0%-4.5%]). Across MSAs, the highest burden was in New York-Jersey City-White Plains (57 diagnoses [UI = 43-73]), with several MSAs in California, Texas, and Florida also showing a high burden.

Geographic differences underscore the need for targeted anal cancer screening outreach and implementation.