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Lower Screening Rates for Breast and
Cervical Cancer in Women With HIV
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IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
Women with HIV had significantly lower rates of screening for breast or cervical cancer than matched HIV-negative women, according to results of a large multiyear comparison in a New England healthcare system [1]. People with or without HIV had similar rates of colon cancer screening.
Researchers working in the Partners Healthcare System in the Boston area noted that cancer has emerged as the leading cause of death in US people with HIV. But scant data examine whether people with HIV get screened for cancer as often as their counterparts without HIV. To address this question, the Partners team compared screening rates for breast, cervical, and colon cancer in screening-eligible people with HIV and a matched cohort of people without HIV infection.
The HIV group came from the Partners Healthcare System, a prospective observational cohort of people in care for HIV in the Boston area, all of them eligible for cancer screening between 2002 and 2016. Researchers matched them in a maximum 1-to-4 ratio to HIV-negative people in the same area based on age, sex, race, year of study entry, and length of follow-up. The outcome of interest was average proportion of time in which screening-eligible people got screened according to guidelines for cervical, breast, and colon cancer. The investigators used nonparametric tests to compare screening rates between the HIV-positive and negative groups considering several clinical and sociodemographic factors.
HIV-positive and negative participants numbered 451 and 1804 eligible for breast cancer screening, 854 and 3416 for cervical cancer screening, and 1825 and 7299 for colon cancer screening. Across these six groups, median ages when observation began were 50, 50, 39.8, 36.1, 50, and 50, and median follow-up years were 5, 5.4, 7.0 6.7, 5.1, and 5.4. Of course women made up 100% of the breast and cervical screening groups, while they comprised one quarter of the colon screening group. Matching for race ensured that similar proportions of HIV-positive and negative participants were white (about one third for breast and cervical screening, about 60% for colon screening), black (about 45% for breast and cervical screening, about 28% for colon screening), and Hispanic (about12% for breast and cervical screening, about 9% for colon screening).
Proportions of participants screened according to guidelines were significantly lower in the HIV group than the HIV-negative group for breast cancer (70.3% versus 81.9%, P < 0.0001) and cervical cancer (51.8% versus 74.2%, P < 0.0001) but not for colon cancer (93.3% and 91.3%, P = 0.14).
Nonparametric analysis determined that having versus not having HIV infection lowered chances of breast cancer screening concordance 15.1% and chances of cervical cancer screening concordance 25.2%. The researchers noted that the disporting between cervical cancer screening rates dropped significantly if they took pap testing every 3 years as the standard for both groups, rather than every year for women with HIV. Among people with HIV infection, more outpatient visits and younger age favored screening concordance for both breast cancer and cervical cancer.
Among all participants, black or Hispanic versus white race/ethnicity lowered chances of breast cancer screening, while black versus white race raised chances of cervical cancer screening. Hispanic versus white ethnicity boosted chances of colon cancer screening. Current smoking versus not smoking lowered chances of screening concordance for all three cancers. English as the primary language upped chances of colon cancer screening, but not breast or cervical cancer screening.
Researchers affiliated with Brigham and Women's Hospital, Massachusetts General Hospital, and Harvard concluded that people with HIV "had significantly lower rates of breast and cervical cancer screening compared with matched HIV-uninfected controls from the same healthcare system." They called for further research on sociodemographic and HIV-related factors, which may affect cancer screening concordance.
In contrast to these findings, breast and cervical cancer screening rates were similar in HIV-positive and negative women in a nationally representative French group of 3022 outpatients [2]. But French investigators rated cervical cancer screening rates suboptimal.
References
1. Hysell K, He W, Chang Y, Dryden-Peterson S, Triant VA. Cancer screening disparities among persons living with HIV (PLWH). IDWeek, October 2-6, 2019, Washington, DC. Abstract 325.
2. Tron L, Lert F, Spire B, Dray-Spira R. Levels and determinants of breast and cervical cancer screening uptake in HIV-infected women compared with the general population in France. HIV Med. 2017;18:181-195.
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