Sociocultural and educational determinants of delayed diagnosis in anal cancer: Insights from a 5-year global social media analysis.

Abstract

7 Background: Global incidence of squamous cell carcinoma of the anal canal (SCAC) is rising, despite preventability through human papillomavirus (HPV) vaccination and earlier detection. Stigma, misinformation, and sociocultural barriers often hinder awareness and help-seeking, leading to delayed diagnosis. Social media listening (SML) provides access to unsolicited, real-world perspectives and can uncover determinants often under-represented in clinical datasets. Methods: A scoping literature review (PubMed/Embase; major oncology congresses, 2020-2025) informed a preliminary taxonomy covering Awareness, Beliefs & Sociocultural Context (A1) and Help-Seeking, Diagnosis & System Navigation (A2). The taxonomy was iteratively refined, translated into Boolean search strategies, piloted and finalized through consensus between independent coders. Global posts mentioning anal cancer (08/2020-08/2025) were retrieved via Talkwalker, and those relevant to the two target themes were isolated using filters. Posts were auto-classified by machine learning algorithms and validated by human coders for sub-theme assignments and sentiments (positive, negative, neutral). Results: Retrieved posts (10,162) were predominantly in English (98.1%); 67.0% originated from US; most posts were from online news portals (44.0%). Within the A1 domain (6,130 posts) negative sentiment outweighed positive sentiment (19.5% vs 9.0%), driven by HPV-related stigma, vaccine skepticism/misinformation, and cultural or religious taboos that suppress open dialogue, particularly among sexual and gender minorities, people living with human immunodeficiency virus (HIV), and older women. Risk was frequently linked to HPV, receptive anal sex, HIV, and missed vaccination, accompanied by calls for culturally competent, stigma-aware education. Within the A2 domain (6,318 posts) positive sentiment outweighed negative sentiment (14.5% vs 7.2%), reflecting optimism from advocacy, provider counseling, and clinical advances (reduced-dose radiotherapy and PD-1–based regimens). Barriers to timely diagnosis included misattribution of symptoms to benign conditions (e.g., hemorrhoids), embarrassment and disclosure fears, lack of routine screening guidance for men, and pandemic-related delays. Across both domains, provider recommendation consistently emerged as a driver for screening uptake and evaluation. Conclusions: Stigma and misinformation contribute delayed diagnosis in SCAC. Priorities to reduce diagnostic delays require stigma-aware messaging, culturally competent education to normalize sexual health dialogue, HPV vaccination for at-risk populations, and provider-prompted early-symptom pathways. Such efforts combined with the availability of PD-1–based regimens offer tangible hope for patients with advanced disease.