Cancer stage at diagnosis in patients infected with the human immunodeficiency virus and transplant recipients

Abstract

Background It is unknown whether immunosuppression results in more aggressive, advanced stage cancers. As cancer stage is influenced both by tumor biology and medical surveillance, we assessed cancer stage in HIV-infected individuals and solid organ transplant recipients, two immunosuppressed groups with differences in healthcare utilization. Methods We used data on all cases of 15 cancer types, diagnosed during 1996–2010 in two studies that linked U.S. cancer registries to HIV and transplant registries. Odds ratios (ORs) for advanced (vs. local) disease were estimated comparing HIV and transplant populations to immunocompetent people in polytomous logistic regression models, adjusted for age, sex, race, registry and year. Results A total of 8,411 of 4.5 million cancer cases occurred in HIV-infected people, and 7,322 of 6.4 million cancer cases occurred in transplant recipients. Compared to immunocompetent people with cancer, HIV-infected people were more likely to be diagnosed with distant stage lung (OR=1.13), female breast (OR=1.99), and prostate cancers (OR=1.57), while transplant recipients had fewer distant stage lung (OR=0.54), female breast (OR=0.75) and prostate cancers (OR=0.72). Both immunosuppressed populations had a shift toward advanced stage melanoma (ORs: HIV=1.97; transplant=1.82) and bladder cancer (ORs: HIV=1.42; transplant=1.54). Conclusions Bladder cancer and melanoma were more likely to be diagnosed at non-local stage in both HIV-infected people and transplant recipients, suggesting a role of immunosuppression in their progression. Additionally, we observed a shift for some common cancers toward later stages in HIV-infected individuals and toward earlier stages in transplant recipients, consistent with differential access to medical care or surveillance.

Clinical Presentation and Outcomes of Prostate Cancer in an Urban Cohort of Predominantly African American, Human Immunodeficiency Virus–infected Patients

“…Prior authors have suggested anecdotally that prostate cancer could be more aggressive in HIV-infected individuals, 12,13 and a recent epidemiologic analysis of U.S. cancer data found an increased odds for distant stage disease. 18 This clinical cohort is consistent with the epidemiologic findings, as a significantly higher proportion of patients presented with advanced stages compared to the general population at our Center.…”

“…Only small case series 14–17 of HIV-infected patients with prostate cancer have been published to date, with conflicting information about stage of presentation and outcomes. One study recently reported that the risk of distant stage prostate cancer was elevated in the HIV-infected population in the U.S. 18 Possible reasons for more advanced staging at diagnosis include biological differences in the tumors, impaired immune surveillance and cytotoxic killing, and reduced PSA screening in the HIV-infected population leading to delayed presentation. 8 …”

Screening for Cancer in Persons Living with HIV Infection

“…78,79 Importantly, PLWH do not have increased prostate cancer incidence, 5 but prostate cancers in PLWH do tend to present at more advanced stage and to be associated with 70% higher cancer-specific mortality. 80,81 For PLWH who have extended life expectancy on ART, considerations for or against prostate cancer screening are the same as in the general population. American Cancer Society (ACS) guidelines support PSA screening for African American men and those with a strong family history of prostate cancer at a young age.…”

“…The incidence of advanced-stage melanoma and melanoma-specific mortality are both approximately doubled in PLWH. 80,81 Common basal and squamous cell skin cancers, as well as rare adnexal and skin appendage neoplasms, are increased nearly 3-fold, but few of these cancers are lethal. 82,83 Particular attention should be paid to PLWH with fair complexion or history of excessive sun exposure, as these characteristics may be common in some AIDS-risk groups and are major risk factors for melanoma and other skin cancers.…”

Pulmonary Diseases in Refugees and Migrants in Europe

“…Primary lung cancer is 2.5 times more common in people living with HIV than in the general population [53] and carries a worse prognosis, possibly because patients tend to present with more advanced disease [54, 55]. …”