Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
We are very pleased that at the BMJ you have highlighted the growing problem with anal cancer rates in the UK.
Several risk factors are known for anal cancer already. These include: women and men with immunosuppression due to medication or HIV infection and innate immune defects; women with previous cervical high grade intraepithelial neoplasia (CIN II/III) or cancer.
These patients often present with high grade squamous intraepithelial lesions (HSIL) of the lower anogenital tract including perianal region and anal canal region. This can be detected by high resolution anoscopy (HRA) -directed biopsies. It is feasible to treat HSIL with topical or ablative treatments. This may well prevent future anal cancer although high quality evidence is still awaited.
Despite the optimism created by the introduction of the HPV vaccine in the eventual elimination of cervical and related anogenital cancers, we will still have a number of deaths due to anal cancer in unvaccinated women over the next 25 years.
There are a number of groups of men and women who are at increased risk of anal cancer. We need to concentrate our efforts in preventing anal cancer in these groups through surveillance and HRA.
Competing interests:
No competing interests
17 June 2014
Tamzin Cuming
Consultant Colorectal Surgeon
Mayura Nathan, Sanjaya Wijeyekoon
Homerton Anal Neoplasia Service, Homerton University Hospital
Re: Anal cancer rates quadruple among UK women in past 40 years
Dear Sir/Madam
We are very pleased that at the BMJ you have highlighted the growing problem with anal cancer rates in the UK.
Several risk factors are known for anal cancer already. These include: women and men with immunosuppression due to medication or HIV infection and innate immune defects; women with previous cervical high grade intraepithelial neoplasia (CIN II/III) or cancer.
These patients often present with high grade squamous intraepithelial lesions (HSIL) of the lower anogenital tract including perianal region and anal canal region. This can be detected by high resolution anoscopy (HRA) -directed biopsies. It is feasible to treat HSIL with topical or ablative treatments. This may well prevent future anal cancer although high quality evidence is still awaited.
Despite the optimism created by the introduction of the HPV vaccine in the eventual elimination of cervical and related anogenital cancers, we will still have a number of deaths due to anal cancer in unvaccinated women over the next 25 years.
There are a number of groups of men and women who are at increased risk of anal cancer. We need to concentrate our efforts in preventing anal cancer in these groups through surveillance and HRA.
Competing interests: No competing interests