Experts are raising the alarm as cases of a lesser-known “taboo” cancer are rising, particularly among women. Top oncologists are urging adults to be aware of the underlying risk factors and symptoms associated with this condition.

When Farrah Fawcett, famed for her role in Charlie’s Angels, disclosed her anal cancer diagnosis in 2006, it ignited a flurry of speculation regarding her personal life among fans and media. However, the primary cause of most anal cancer cases is the human papillomavirus (HPV), a prevalent sexually transmitted infection affecting around 80 million people in the United States at some point in their lives.

While the majority of HPV infections do not lead to serious health issues, certain high-risk strains can gradually compromise cell DNA, potentially resulting in cancer many years later.

Fawcett lost her battle with the disease in 2009 at the age of 62. During her diagnosis, anal cancer was predominantly perceived as affecting gay men. Studies at the time suggested that men who engage in anal sex were up to 20 times more likely to develop the disease, highlighting the method of transmission for the infection.

Fawcett died in 2009 at age 62. And at the time she was diagnosed, anal cancer was largely seen as a disease of gay men, with research estimating they could be 20 times more likely to be diagnosed with the disease – anal sex is a primary mode of transmission for the infection.

But Dr Amar Rewari, chief of radiation oncology at Luminis Health and adjunct associate professor at Johns Hopkins, told the Daily Mail his patient demographic has started to shift. More and more, he is seeing women over the age of 50 in his practice alongside gay and bisexual men.

Each year, anal cancer affects about 10,000 Americans, about 70 percent of whom are women. It kills just under 2,200, with an even split between men and women. 

The overall risk of being diagnosed with the disease is about one in 500, according to the American Cancer Society, and it accounts for just 0.5 percent of all new cancer cases. 

Farrah Fawcett, a 1970s TV icon best known for Charlie’s Angels, revealed her anal cancer diagnosis in 2006. Fawcett died in 2009 at age 62 after the cancer spread. (Pictured: Fawcett with her longterm partner, actor Ryan O’Neal, who died in 2023)

Anal cancer in the US had seen an average yearly increase of three percent from 2001 to 2015, but federal data suggest there has been a 46 percent surge between 2005 and 2018, largely among older women. (Like Erin Sullivan-Wagner, who was diagnosed at 48 years old.)

Cases rise as people age, and women are approximately twice as likely to contract it.

In one recent case report from the American Journal of Case Reports, doctors wrote about an unnamed 59-year-old woman who dismissed months of rectal bleeding as hemorrhoids. By the time she sought help, an MRI revealed a sizable tumor, and she was diagnosed with early-stage squamous cell carcinoma.

Doctors linked her cancer to an HPV infection. She later shared that she had engaged in anal sex with her long-term partner.

Since 2009, rates in women 40 to 64 have stayed high with a steady 3.7 cases per 100,000 women in that demographic. 

Despite a long-term increase since 2000, men’s rates have been in clear decline since their 2009 peak, falling by approximately 11 percent. 

Dr Mona S Jhaveri, cancer researcher and founder of Music Beats Cancer, told the Daily Mail that about 88 percent of anal cancers are caused by HPV. The remaining 12 percent are attributed to other causes, primarily driven by chronic inflammation and immunosuppression.

How HPV affects anal cancer

HPV encompasses more than 200 viruses. Of those, about 30 strains affect the genitals, including the vagina, cervix, penis, scrotum, rectum and anus. Jhaveri noted HPV types 16 and 18 are most associated with anal cancer. 

Rewari explained that it ‘spreads through direct skin or mucosal contact,’ and said that ‘having multiple partners or engaging in receptive anal sex increases the chance of exposure simply because there are more opportunities for the virus to spread.’

Despite the associated stereotypes, Rewari told the Daily Mail this disease ‘is not limited to any one group,’ and that ‘anyone who is sexually active can contract HPV.’ 

HPV lies dormant for months, years or even decades in the anal canal. Over time, it disrupts normal cell processes and chips away at their natural defense systems, which can cause mutations in genes meant to suppress tumors. 

‘That slow, silent process can eventually allow abnormal cells to grow into cancer,’ Rewari said.

Erin Sullivan-Wagner, 66, (pictured with her grandson) was diagnosed with anal cancer in 2008 when she was 48 years old

The virus produces proteins called E6 and E7, which disrupt normal cell cycles and lead to the formation of precancerous lesions, called anal dysplasia. 

HPV can also cause cervical, vaginal, penile, vulvar and oropharyngeal (throat, tongue and cheek) cancers. 

‘Key risk factors are high-risk HPV infection, history of anal warts or other HPV-related disease, immunosuppression, prior cervical or vulvar cancer, multiple sexual partners, receptive anal intercourse, smoking, female sex and age,’ Dr Krushangi Patel, a medical oncologist at City of Hope in California told the Daily Mail.

It is possible, though uncommon, for anal cancer to develop without HPV’s direct involvement, solely driven by chronic inflammation.

Anal cancer is almost as frequent in patients with Crohn’s disease as colorectal cancer (42 percent and 50 percent, respectively). 

Chronic inflammation leads to the formation of deep ulcers and sores that tunnel through the intestinal wall. As these deep ulcers worsen, they can make a tunnel outwards from the inside of the intestine seeking a way to drain the buildup of dead cells, bacteria and fluid.

The tunnel eventually connects the inflamed intestine to another structure. In the case of a perianal fistula, it connects the intestine to the skin around the anus, creating an abnormal drainage channel. 

Once it ruptures through to the surface, the tract it creates remains as a fistula, which continues to drain fluid and pus from the still-inflamed intestine.

The above graph from the American Cancer Society shows the gradual increase in anal cancer cases from 1975 through 2023, the latest data available

The chronic inflammatory environment itself, with its constant cycle of tissue damage and repair, releases reactive molecules that cause DNA mutations in the rapidly dividing cells, which can eventually lead to cancer.

In stage one anal cancer cases, the five-year survival rate is 85 percent, according to the American Cancer Society. If it spreads to distant organs, however, that rate dwindles to 36 percent. 

Why are cases growing? 

While the HPV vaccine can prevent about 90 percent of infections, the shot wasn’t rolled out until 2006. Additionally, it was only recommended for girls and women ages nine to 26, leaving older women unprotected. 

Now, men and women between 27 and 45 can get the shot if they missed out on it when they were younger. However, it still has not been approved for those over 45. 

‘We are seeing the long-term effects of infections that occurred before HPV vaccination existed,’ Rewari told the Daily Mail. ‘People who were infected decades ago are now at the age when these cancers tend to appear. 

‘Longer life spans, more people living with immune suppression, and better awareness also contribute to the increase.’

The one million Americans living with human immunodeficiency virus (HIV) are also thought to be at a greater risk of developing anal cancer, as HIV suppresses the body’s immune system from fighting off viruses like HPV. 

HIV-positive individuals are also at a greater risk of repeated HPV infections, raising their risk of anal cancer. 

Experts told the Daily Mail that avoiding smoking can lower the risk of anal cancer, as it is thought to introduce thousands of carcinogens into the body that can travel to the anus and weaken the immune system. 

Mainly, however, they encourage people to get an HPV vaccine and practice safe sex.  

‘The most powerful prevention tool we have is the HPV vaccine,’ Jhaveri said.

‘We need to advocate for safe sex practices such as using condoms, and reducing the number of partners can help avoid an HPV infection.’

Symptoms of anal cancer

Symptoms include anal bleeding, lumps near the anus and pain and pressure around the area.

Rewari said signs can also include changes in bowel habits or mucus discharge – ‘these symptoms should never be ignored.’

In fact, ignoring signs of anal cancer can cause the disease to spread to other organs. 

Rewari suggests anyone with symptoms that persist for more than a few weeks should see a doctor, adding that ‘early detection gives the best chance for cure.’

The above graph from a 2022 study in the Journal of Clinical Oncology shows an increase in anal cancer in men and women above the age of 50 in 2014 – 2018 compared to 2001 – 2005

While it may seem like a given to report symptoms instantly, the stigma around the condition – both based on its uncomfortable symptoms and its connection to sex – can make it difficult for some.

Its taboo nature can stop someone from ‘reporting what [they] suspect might be anal cancer because they are afraid of being judged for their sex practices,’ Dr Carole Lieberman, a psychiatrist and public health expert in Beverly Hills, told the Daily Mail. ‘Women are especially uncomfortable talking about this with their male doctors.’

But, Rewari said, ‘these are medical issues, not moral ones – honest conversations can make a real difference.’