Breast cancer in women living with HIV: A first global estimate

Abstract

There is a growing population of older women living with HIV/AIDS (WLWHA). Breast cancer is a common cancer in women worldwide, but the global number of breast cancers in WLWHA is not known. We estimated, for each UN sub-region, the number and age distribution of WLWHA who were diagnosed with breast cancer in 2012, by combining IARC-GLOBOCAN estimates of age-country specific breast cancer incidence with corresponding UNAIDS HIV prevalence. Primary analyses assumed no HIV-breast cancer association, and a breast cancer risk reduction scenario was also considered. Among 16.0 million WLWHA aged 15+ years, an estimated 6,325 WLWHA were diagnosed with breast cancer in 2012, 74% of whom were in sub-Saharan Africa, equally distributed between Eastern, Southern and Western Africa. In most areas, 70% of HIV-positive breast cancers were diagnosed under age 50. Among all breast cancers (regardless of HIV status), HIV-positive women constituted less than 1% of the clinical burden, except in Eastern, Western and Middle Africa where they comprised 4-6% of under age 50 year old breast cancer patients, and in Southern Africa where this patient subgroup constituted 26 and 8% of breast cancers diagnosed under and over age 50 respectively. If a deficit of breast cancer occurs in WLWHA, the global estimate would reduce to 3,600. In conclusion, worldwide, the number of HIV-positive women diagnosed with breast cancer was already substantial in 2012 and with an expected increase within the next decade, early detection and treatment research targeted to this population are needed.

Impact of HIV infection on baseline characteristics and survival of women with breast cancer

“…The European AIDS Clinical Society already recommends mammographic screening for WLWH ≥50 years [58]. Nonetheless, in most regions of the world, 70% of WLWH are diagnosed with breast cancer under the age of 50 [4] and the implementation of population-mammographic screening in low-resource settings such as Sub-Saharan Africa is very low [59]. In this region, women often present with late stage disease, thus the use of clinical breast examinations by a health professional could be considered.…”

“…As these women become older, their risk of developing cancer increases, including non-AIDS defining malignancies such as breast cancer [2]. Breast cancer is still the leading cause of cancer-related death among women worldwide [3] and its burden is increasing among specific subgroups of women, such as those with HIV/AIDS [4]. Globally, WLWH constitute <1% of patients with breast cancer, but in high endemic regions, such as Southern Africa, WLWH represent 26% of breast cancers diagnosed among women <50 years.…”

Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study

“…At the patient level, fear of disfigurement, of stigmatisation or of treatment side-effects have been documented [6, 7], whilst the risks of incurring catastrophic health expenditures are large [8, 9]. The influence of traditional and spiritual healers on receipt of conventional cancer care has not been quantified, and finally, in HIV-endemic regions of SSA, the evidence base on management of the HIV-positive woman with breast cancer is very limited [10].…”

Preexisting morbidity profile of women newly diagnosed with breast cancer in sub‐Saharan Africa: African Breast Cancer—Disparities in Outcomes study

“…Such profiles are likely to differ across SSA countries at differing stages of economic, developmental and lifestyle transitions, that is, different in SSA middle income countries (MICs) from low income countries (LICs) 13,14 . Furthermore, in addition to the aforementioned conditions, the setting‐pertinent infectious disease of HIV needs to be taken into account due to the ageing HIV‐positive population successfully treated with antiretroviral drugs 15 . Establishing these SSA‐specific morbidity profiles of breast cancer patients will form a first step to inform priorities for feasible management strategies in constrained public health systems.…”

“…13,14 Furthermore, in addition to the aforementioned conditions, the setting-pertinent infectious disease of HIV needs to be taken into account due to the ageing HIV-positive population successfully treated with antiretroviral drugs. 15 Establishing these SSA-specific morbidity profiles of breast cancer patients will form a first step to inform priorities for feasible management strategies in constrained public health systems.…”