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Background: Human papillomavirus-associated anogenital carcinogenesis depends on poorly defined cofactors. Smoking was recently suggested to increase the risk of anal cancer more in premenopausal women than in postmenopausal women. Thus, we used our population-based anal cancer case-control study in Denmark and Sweden to test this hypothesis. Two control groups were used: 1 population control subjects women and men and 2 patients with rectal adenocarcinoma women and men. Odds ratios ORs , calculated from logistic regression analyses, were used as measures of relative risk.