One half of people living with HIV are women, and the use of antiretroviral therapy (ART) has changed their life expectancy and causes of mortality. It has been observed that there is an overall increase in the burden of reproductive cancers among HIV infected women. As such preventative measures need to be the focus of their care. Here we determine the incidence of gynecological cancers (GYNC) and evaluate screening adherence in our female HIV/AIDS population.
In an IRB-approved protocol, we reviewed the records of 1,821 female HIV/AIDS patients from 2002 to 2014. Of these 1,089 followed in our outpatient HIV clinic. Information was collected on demographics, cancer screenings, CD4 counts, cancer history and cancer risk factors.
Of 1,812 charts reviewed, 78 were found to have one or more malignancy. In terms of GYNC, breast cancer (BC) occurred most frequently in 13 patients (35%), prevalence of 1.2%, followed by cervical cancer (CC) in 12 patients (32%), prevalence of 1.1%, and anal dysplasia in 7 patients (19%), prevalence of 0.6%. Of the 1,089, 89% had one recorded Pap smear and 50% continued with screening per current guidelines. 573 patients who followed in clinic were over 50 years old, 52% had at least one mammogram and 29% continued with screening per current guidelines. Of the BC cases, 4 presented before the age of 40, 4 were diagnosed with screening mammograms and 5 did not participate in screening and presented with masses. The average age at diagnosis was 43 (range 24-60), and none of these patients had additional risk factors for BC.
Our one-time screening rates of CC are higher than BC, but for both the continuation rate is poor. Interestingly, BC is presenting at a younger age in our population. What is concerning is that the average age in our female HIV/AIDS population is only 50 and the average at diagnosis of BC is 43. Also of the cases we found, there were no additional traditional risk factors that would prompt earlier screening. We assert that there is a need for measures to improve our patients’ adherence to current screenings and re-evaluation of our current timeline for screening mammograms in our female HIV/AIDs population.
A. Tlamsa, None
M. Kang, None
J. Zucker, None
D. Cennimo, None