Anal cancer incidence, including in situ and invasive carcinoma is on the rise in North America, with a sharp increase over the past several decades. Oncogenic types of human papilloma virus (HPV) have been shown to be the principle cause of both cervical and anal cancer. HPV is the most common sexually transmitted disease in the United States and anal intercourse is a major risk factor for acquiring the infection. Anal cancer affects both men and women; women having the highest overall likelihood of developing carcinomas of the anorectal region. At risk populations for developing anal carcinoma include men who have sex with men, HIV positive individuals (including those without a history of anal intercourse), immunocompromised patients including a history of organ transplant, those with a history of genital warts, and women with abnormal vulvar, vaginal or cervical Pap results.