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

Keller, Sara C.; Momplaisir, Florence; Re, Vincent Lo; Newcomb, Craig; Liu, Qing; Ratcliffe, Sarah J.; Long, Judith A.

doi:10.1080/09540121.2013.855700

Cited by 15 publications

(16 citation statements)

References 25 publications

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“…However, two studies have reported that colorectal cancer screening rates in PLWH are 20% lower than in the general population. 74,75 Increasing PLWH participation in colorectal cancer screening would be expected to improve their survival.…”

Section: Site-specific Screening Approachmentioning

confidence: 99%

Screening for Cancer in Persons Living with HIV Infection

et al. 2016

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Survival with human immunodeficiency virus (HIV) infection has greatly improved due to effective antiretroviral therapy (ART). As infectious complications have declined, malignancy now accounts for over one-third of deaths among people living with HIV (PLWH). Based on practices in the general population, cancer screening of PLWH can decrease both morbidity and mortality. In this article, we review and consider directed approaches for colorectal, breast, cervical and lung cancer screening. Furthermore, routine physical examinations may detect lymphomas and skin, anal and oral cancers. Comprehensive cancer prevention in PLWH should also include ART adherence, vaccination against oncogenic viruses, treatment of hepatitis viruses and smoking cessation. Cancer screening for PLWH warrants further research on safety and efficacy as well as targeted efforts to increase adherence.

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Section: Site-specific Screening Approachmentioning

confidence: 99%

Screening for Cancer in Persons Living with HIV Infection

et al. 2016

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“…In single-centre studies, the proportions of persons with HIV aged 50 years and older who received colorectal cancer screening has ranged from 46.9% to 55.6% [ 14 - 17 ]. In a large study using United States Medicaid claims data on beneficiaries in five states, only 35.8% of 22,928 age-eligible persons with HIV underwent colorectal cancer screening between 1999 and 2007 [ 18 ]. However, these findings likely underestimate the extent of screening somewhat because claims for fecal occult blood testing were not examined in this study [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a large study using United States Medicaid claims data on beneficiaries in five states, only 35.8% of 22,928 age-eligible persons with HIV underwent colorectal cancer screening between 1999 and 2007 [ 18 ]. However, these findings likely underestimate the extent of screening somewhat because claims for fecal occult blood testing were not examined in this study [ 18 ]. Nonetheless, taken as a whole, the existing evidence suggests that efforts to improve colorectal cancer screening rates in persons with HIV are needed.…”

Section: Discussionmentioning

confidence: 99%

“…In light of these data, an aging cohort of persons with HIV and evidence that screening for colorectal cancer reduces mortality associated with this disease, integration of age-appropriate colorectal cancer screening into the care of patients with HIV will be increasingly required [ 11 - 13 ]. Although several studies suggest that colorectal cancer screening is underutilized in HIV-infected relative to non-infected patients, there are no population-based data examining the utilization of colorectal cancer screening in persons with HIV [ 14 - 18 ]. We therefore compared rates of colorectal cancer screening among 50 to 65 year old men living with and without HIV infection in Ontario, Canada, a setting of universal health coverage and home to over 40% of Canada’s population of persons with HIV [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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A population-based study of the extent of colorectal cancer screening in men with HIV

Antoniou

Jembere

Saskin

et al. 2015

BMC Health Serv Res

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BackgroundBecause of the increased life-expectancy of persons with HIV, the need for age-appropriate colorectal cancer screening among these patients will increase. We examined rates of colorectal cancer screening among HIV-infected men aged 50 to 65 years.MethodsWe used Ontario’s administrative databases to identify all men between the ages of 50 and 65 years who were alive on April 1, 2007, and identified HIV-infected men using a validated case-finding algorithm. We excluded men with a history of colorectal cancer, anal cancer, inflammatory bowel disease and any colorectal investigation in the preceding five-years, and used multivariable regression to compare rates of colorectal cancer screening between men with and without HIV during five years of follow-up.ResultsWe identified 743,801 men between the ages of 50 and 65 years, of whom 1,432 (0.19%) were HIV-infected. The proportions of men with and without HIV who underwent any screening during the 5-year follow up period were 49.1% (95% CI 46.5% to 51.7%) and 41.4% (95% CI 41.3% to 41.5%), respectively. Compared with HIV-negative men, men with HIV had lower rates of fecal occult blood testing [adjusted rate ratio (aRR) 0.74; 95% confidence interval (CI) 0.63 to 0.87] and barium-enema radiography (aRR 0.66; 95% CI 0.39 to 1.12), but higher rates of colonoscopy (aRR 1.24; 95% CI 1.13 to 1.37), flexible sigmoidoscopy (aRR 1.72; 95% CI 1.28 to 2.30) and rigid sigmoidoscopy (aRR 2.98; 95% CI 2.26 to 3.93).ConclusionAs with the general population of men aged 50 to 65 years, less than half of the population of men with HIV received colorectal cancer screening. Strategies are required to improve uptake of this intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0711-9) contains supplementary material, which is available to authorized users.

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“…Compared with HIV-uninfected patients, PLWHA may be screened and treated for NCDs at lower rates[10, 13, 27, 28]. ID providers report less comfort managing diabetes (DM), hypertension (HTN), hyperlipidemia (HL) and depression than generalists[29] and have four times increased odds of referring for HTN or DM management[30].…”

Section: Introductionmentioning

confidence: 99%

Non-Communicable Disease Preventive Screening by HIV Care Model

et al. 2017

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ImportanceThe Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population.ObjectiveThe primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening. We hypothesized that primary care models that included generalists would have higher preventive screening rates.DesignProspective observational cohort study.SettingPartners HealthCare System (PHS) encompassing Brigham & Women’s Hospital, Massachusetts General Hospital, and affiliated community health centers.ParticipantsPLWHA age >18 engaged in active primary care at PHS.ExposureHIV care model categorized as infectious disease (ID) providers only, generalist providers only, or ID plus generalist providers.Main Outcome(s) and Measures(s)Odds of screening for metabolic/CVD outcomes including hypertension (HTN), obesity, hyperlipidemia (HL), and diabetes (DM) and cancer including colorectal cancer (CRC), cervical cancer, and breast cancer.ResultsIn a cohort of 1565 PLWHA, distribution by HIV care model was 875 ID (56%), 90 generalists (6%), and 600 ID plus generalists (38%). Patients in the generalist group had lower odds of viral suppression but similar CD4 counts and ART exposure as compared with ID and ID plus generalist groups. In analyses adjusting for sociodemographic and clinical covariates and clustering within provider, there were no significant differences in metabolic/CVD or cancer screening rates among the three HIV care models.ConclusionsThere were no notable differences in metabolic/CVD or cancer screening rates by HIV care model after adjusting for sociodemographic and clinical factors. These findings suggest that HIV patients receive similar preventive health care for NCDs independent of HIV care model.

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

Cited by 15 publications

References 25 publications

Screening for Cancer in Persons Living with HIV Infection

Screening for Cancer in Persons Living with HIV Infection

A population-based study of the extent of colorectal cancer screening in men with HIV

Non-Communicable Disease Preventive Screening by HIV Care Model

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