Breast cancer

Introduction

Breast cancer is the most common cancer worldwide in women and the second leading cause of cancer-related death in women in the United States. When compared with the general population, PLWHA have a similar or slightly lower risk of breast cancer1-3, the reason for which does not appear to be related to hormone deficiency2-4. Low breast cancer risk with HIV has been reported to be specifically linked to C-X-C chemokine receptor type 4 (CXCR4)-using variants of HIV. Binding of the HIV envelope protein to CXCR4 expressed by the neoplastic breast cells may induce apoptosis resulting in a lesser risk of breast cancer.

Unusual clinical presentations and rapid progression have been reported, suggesting that breast cancer may behave more aggressively in this setting5.


Screening and Prevention

Screening modalities for breast cancer include mammography, screening ultrasonography, clinical and self-breast examination, MRI and breast tomosynthesis. Mammography, however, is the best studied and proven method to reduce mortality from breast cancer in the average-risk population1.

Mammography should be performed annually in women aged >50 years (strong recommendation, high quality evidence). In women aged 40–49 years, providers should perform individualized assessment of risk for breast cancer and inform them of the potential benefits and risks of screening mammography (strong recommendation, high quality evidence)5.

A meta-analysis of survival data from population-based RCTs from the U.S., Denmark, UK and Sweden suggests that screening for breast cancer is most appropriate for patients with a life expectancy greater than 10 years6.


References

  1. Mania D. and Aboulafia DM. Screening guidelines for non-AIDS defining cancers in HIV-infected individuals. Curr Opin Oncol. 2013 Sep;25(5):518-525.
  2. Goedert JJ, Schairer C, McNeel TS, et al. Risk of breast, ovary, and uterine corpus cancers among 85.268 women with AIDS. Br J Cancer 2006; 95:642–648.
  3. Dauby N, De Wit S, Delforge M, et al. Characteristics of non-AIDS-defining malignancies in the HAART era: a clinico-epidemiological study. J Int AIDS Soc 2011; 14:16.
  4. Frisch M, Biggar RJ, Engels EA, Goedert JJ. Association of cancer with AIDS-related immunosuppression in adults. JAMA 2001; 285: 1736-1745.
  5. Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America. November 2013.
  6. Lee SJ, Boscardin WJ, Stijacic-Cenzer I, et al. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ 2013; 346:e8441.