Characteristics of colorectal cancer in the human immunodeficiency virus-infected African American population

Abstract

Colorectal Cancer (CRC) is the second leading cause of cancer mortality in the United States. African Americans (AAs) have the highest incidence of CRC of any American ethnic group. Survival from CRC in AAs is lower than in Caucasians, and the mean age of CRC development in AAs is younger. The AA community also has a high rate of HIV infection, accounting for 50.3% of all cases despite making up only 13.6% of the population. This retrospective cohort study identified 17 AA HIV patients with CRC. The patients were matched with 42 HIV-negative CRC patients (controls), based on age, sex, and TNM stage. Data were obtained from 3 hospitals in New Jersey: St. Michael's Medical Center, Trinitas Medical Center and St. Joseph's Medical Center. The age, sex, HIV status, tumor site, stage, drug usage, Hepatitis C status, and survival outcome of subjects and controls were compared. Data from the Surveillance Epidemiology & End Results (SEER) specific to AAs were also compared. The mean age of CRC diagnosis was younger, 50.7 years (median: 52 years, range: 35-71 years), versus 59.42 years (median: 66 years) (P < 0.0001) in the SEER AA population. Of the patients, 29.4% were diagnosed with CRC at less than 45 years of age, versus only 6.35% of the SEER AA population (P < 0.0002). The male-to-female ratio was 11:6. Seven individuals used IV drugs, and 7 had hepatitis C. The mean CD4+ T-cell count was 510.81 cells/mm(3) (median 419). At the time of CRC diagnosis, the average duration of HIV infection was 7.6 years (range 0-22.4 years).Of patients, 87.5% had left-sided CRC, versus 57.55% of the SEER population (P < 0.024). Of the patients, 52.94% had stage III-IV, at diagnosis, versus 43.84% in SEER. There was no statistically significant survival difference between the cases and controls. In our cohort of HIV-infected AA's with CRC, the staging and outcome of CRC did not appear to be affected by the degree of immunosuppression. HIV-infected AA with CRC presented with a higher percentage of left-sided CRC than AA's without HIV. Additionally, AAs with HIV tended to be younger at the time of CRC diagnosis. Our findings suggest that screening for CRC should be offered to HIV-infected AAs before the age of 45, and that sigmoidoscopy with fecal occult blood testing might be an acceptable screening modality. However, the exact age of initiation, optimal frequency, and preferred method of screening (colonoscopy vs. sigmoidoscopy) in this population requires further study.

Human Immunodeficiency Virus (HIV) Infection and Cancer

“…the uninfected controls had already presented with advanced stage colorectal cancer. Interestingly, the survival time was similar for both groups in this study [62].…”

“…Kumar et al studied the clinical presentations of colorectal cancer in a retrospective study of 17 HIV-1-infected African Americans and 42 uninfected matched controls. The mean age of colorectal cancer diagnosis in the HIV-1-infected population was 50.70 versus 59.42 years in the control group [62]. Furthermore, 29.4% of the HIV-1-infected patients in this study were diagnosed with colorectal cancer at a younger age (<45 years) versus 6.35% for the control group.…”

Colorectal cancer incidence and screening in US Medicaid patients with and without HIV infection

“…Many studies have suggested that PLWH were more likely to be diagnosed with CRC, often at an earlier age or with a more aggressive malignancy (Patel et al, 2008; Berretta et al, 2009; Bini et al, 2009; Kumar et al, 2012; Wasserberg et al, 2007). However, many of these studies were single-center (Berretta et al, 2009; Wasserberg et al, 2007), and most did not adjust appropriately for age.…”

“…Studies looking at colorectal cancer (CRC) risk in PLWH have been mixed. Some studies have shown that compared to HIV-uninfected individuals, PLWH may have worse survival (Berretta et al, 2009), more advanced disease at presentation (Bini, Green, & Poles, 2009), more neoplasms (Bini et al, 2009), a diagnosis at an earlier age (Kumar et al, 2012; Wasserberg, Nunoo-Mensah, Gonzalez-Ruiz, Beart, & Kaiser, 2007), or increased rates of CRC (Patel et al, 2008). Other studies have shown that PLWH either have no difference in incidence of CRC (Silverberg et al, 2011) or a lower incidence of CRC (Frisch et al, 2001; Engels et al, 2008; Silverberg et al, 2011; Van Leeuwen et al, 2009) than those without HIV.…”

Clinicopathologic Features of Colorectal Carcinoma in HIV-Positive Patients

“…Prior reports of colorectal cancer in HIV + persons include case series, case–control studies, and a single retrospective multi-institutional study (10, 12, 13, 17). Similar to prior reports, case patients in the current study had an early onset of cancer (median 55 years) compared with population-based (Surveillance Epidemiology and End Results) estimates (median 69 years).…”