Malignant neoplasm of the anus and anal canal
Meaning of malignant neoplasm of the anus and anal canal: For the purposes of this Statement of Principles, malignant neoplasm of the anus and anal canal: (a) means a primary malignant neoplasm arising from the epithelial cells of the anus or anal canal; and (b) includes: (i) adenocarcinoma; (ii) adenocarcinoma in situ; (iii) carcinoma in situ; (iv) high-grade anal squamous intra-epithelial lesion (HSIL); and (v) squamous cell carcinoma; and (c) excludes: (i) atypical squamous cell histology of undetermined significance in the anal canal; (ii) haematolymphoid tumours including Hodgkin's lymphoma and non-Hodgkin lymphoma; (iii) low-grade anal squamous intra-epithelial lesion (LSIL); (iv) malignant melanoma; (v) mesenchymal tumours including soft tissue sarcoma; (vi) neoplasms of the perianal skin (anal margin); and (vii) neuroendocrine tumours.
Reasonable Hypothesis (RH) — Statement of Principles No. 82 of 2022
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the anus and anal canal or death from malignant neoplasm of the anus and anal canal with the circumstances of a person's relevant service:
- (1)having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of malignant neoplasm of the anus or anal canal; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the anus or anal canal; and if smoking has ceased before the clinical onset of malignant neoplasm of the anus or anal canal, then that onset occurred within 20 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
- (2)having infection of the epithelium of the anal canal with a specified human papilloma virus before the clinical onset of malignant neoplasm of the anus or anal canal;
Note: specified human papillomavirus is defined in the Schedule 1 - Dictionary.
- (3)having receptive anal intercourse at least 2 years before the clinical onset of malignant neoplasm of the anus or anal canal;
- (4)having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the anus or anal canal;
- (5)taking an immunosuppressive drug for organ or tissue transplantation for at least the 1 year before the clinical onset of malignant neoplasm of the anus or anal canal;
Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.
- (6)having perianal manifestations of Crohn disease for at least the 3 years before the clinical onset of malignant neoplasm of the anus or anal canal;
Note: perianal manifestations of Crohn disease is defined in the Schedule 1 - Dictionary.
- (7)having systemic lupus erythematosus for at least 3 years before the clinical onset of malignant neoplasm of the anus or anal canal;
- (8)having psoriasis for at least 3 years before the clinical onset of malignant neoplasm of the anus or anal canal;
- (9)inability to obtain appropriate clinical management for malignant neoplasm of the anus and anal canal;
Aggravation-only factors: the factors in subsection 9(9) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
Balance of Probabilities (BoP) — Statement of Principles No. 83 of 2022
7 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, malignant neoplasm of the anus and anal canal or death from malignant neoplasm of the anus and anal canal is connected with the circumstances of a person's relevant service:
- (1)having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of malignant neoplasm of the anus or anal canal; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the anus or anal canal; and if smoking has ceased before the clinical onset of malignant neoplasm of the anus or anal canal, then that onset occurred within 20 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
- (2)having infection of the epithelium of the anal canal with a specified human papillomavirus before the clinical onset of malignant neoplasm of the anus or anal canal;
Note: specified human papillomavirus is defined in the Schedule 1 - Dictionary.
- (3)having receptive anal intercourse at least 2 years before the clinical onset of malignant neoplasm of the anus or anal canal;
- (4)having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the anus or anal canal;
- (5)taking an immunosuppressive drug for organ or tissue transplantation for at least the 1 year before the clinical onset of malignant neoplasm of the anus or anal canal;
Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.
- (6)having perianal manifestations of Crohn disease for at least the 3 years before the clinical onset of malignant neoplasm of the anus or anal canal;
Note: perianal manifestations of Crohn disease is defined in the Schedule 1 - Dictionary.
- (7)inability to obtain appropriate clinical management for malignant neoplasm of the anus and anal canal;
Aggravation-only factors: the factors in subsection 9(7) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
