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WASHINGTON — Anal cancer is a major issue in the older adult population, especially for those identifying as sexually diverse, and it is “not yet talked about enough,” Klint Peebles, MD, said at the ElderDerm 2025 conference on dermatology in the older patient population.

Between 2001 and 2015, the incidence of anal squamous cell carcinoma rose 2.7% per year in the US, according to a published analysis of the US Cancer Statistics dataset, with statistically significant increases in people aged 50 years or older, especially in women. Moreover, deaths from anal cancer rose 3.1% each year during that period.

“Not only are rates rising, but we’re seeing later-stage diagnoses rise as well,” said Peebles, a dermatologist with Kaiser Permanente, Mid-Atlantic Permanente Medical Group, in Washington, DC, and suburban Maryland. “We’re not catching them early in certain groups.” Peebles discussed this issue in a presentation titled “Intersection of aging, gender & sexual diversity, and dermatology” at the meeting hosted by the George Washington School of Medicine and Health Sciences, Washington, DC.

In 2024, there were an estimated 10,540 new cases of anal cancer (0.5% of all new cancer cases), with higher rates in women than in men. Notably, in women aged 65-74 years or older, anal cancer is more common than cervical cancer.

Cervical cancer screening generally ends at age 65 for women at average risk. But anal cancer hasn’t even peaked in this population by then, Peebles noted, referring to a 2021 report from the HPV Information Centre. “For men, it starts to peak at age 60 or so and then never comes down.”

Among subpopulations, people living with HIV — and especially men who have sex with men (MSM) who are living with HIV — have the highest rates of anal cancer. “Men who have sex with men and living with HIV are 80 times more likely to develop anal cancer than HIV-negative individuals,” Peebles said.

One in 10 MSM living with HIV will get anal cancer over their lifetime, and “we’re seeing this happen regardless of antiretroviral therapy.”

Challenges, Disparities of a Growing Population

Understanding the epidemiology of anal cancer is part of the broader need for dermatologists to recognize the health challenges faced by LGBTQ older adults, said Peebles, chair of the American Academy of Dermatology (AAD)’s Access to Dermatologic Care Committee and past chair of the AAD’s LGBTQ/Sexual and Gender Minority Expert Resource Group.

An estimated 250,000 US adults older than 65 years identify as transgender, about 0.5% of that age group, mirroring the proportion in the general population.

An estimated 3 million LGBTQ adults older than 50 years currently live in the US, and that’s expected to grow to 7 million by 2030.

Many LGBTQ older adults face significant economic, housing, and healthcare barriers rooted in a lifetime of discrimination. More than half report employment and/or housing discrimination, and one third live at or below the federal poverty level. Among LGBTQ seniors, “there are many concerns about long-term care settings,” Peebles added, “with many trans older adults being forced, for instance, to hide their identify in order to get accepted” into long-term care and to feel safe and secure there.

These disparities can directly influence dermatologic care, emphasized Peebles, who urged dermatologists to provide trauma-informed care, which is a distinct evidence-based model that acknowledges the substantial impact of trauma while offering the necessary support for healing. In addition, it is important to differentiate between sex/sex assigned at birth, gender identity, gender expression, sexual orientation, and sexual behavior. “All of these are very different,” Peebles said.

An Important Start on Anal Cancer Screening

The ANCHOR trial conducted at 25 US clinical sites and published in The New England Journal of Medicine in 2022, demonstrated that routine screening for and removal of anal high-grade squamous intraepithelial lesions could significantly lower the risk for anal cancer in people living with HIV. The findings informed the first federal screening guidelines released in 2024, co-sponsored by the Office of AIDS Research at the National Institutes of Health, the CDC, and the HIV Medicine Association affiliated with the Infectious Diseases Society of America.

The guidelines recommend that all adults living with HIV be assessed at least once a year for anal abnormalities and undergo digital anorectal examination. Those younger than 35 years with anal symptoms or abnormalities on examination should undergo standard anoscopy, people older than 35 years should have laboratory-based screening (with follow-up high-resolution anoscopy, if indicated) if they are MSM, transgender women, or aged 45 years or older.

Consensus screening guidelines from the International Anal Neoplasia Society similarly recommend screening in all MSM and transgender women living with HIV who are aged 35 years or older. A lower risk category for screening requiring shared decision-making recommends screening for those with perinatal warts who are 45 years or older.

“I’ve helped to identify a handful of invasive anal cancers over the last year alone in the older adult population who are living with HIV and identify as MSM,” Peebles said at the meeting.

“This was only after I initiated the conversation about their risk factors for anal cancer, which then led to appropriate screening,” Peebles explained after the meeting.

A 2018 survey sponsored by the American Association of Retired Persons and the University of Michigan found that about 40% of people aged 65-80 years are sexually active, condom use is low, and only 17% had discussed sexual health with their healthcare provider in the prior 2 years.

“It is important to remember this context, to gather relevant information about sexual behaviors, and to remember that sexual behaviors are entirely distinct from sexual orientation and attraction,” Peebles told Medscape Medical News after the meeting.

Peebles reported having no relevant disclosures.