ONCOmmunity

Cervical cancer incidence stratified by age in women living with HIV compared with the general population in the United States, 2002-2016.

By: Elizabeth A Stier, Eric Engels, Marie-Josèphe Horner, Billy Robinson, Baozhen Qiao, Jennifer Hayes, Rana Bayakly, Bridget J Anderson, Lou Gonsalves, Karen S Pawlish, Diego Zavala, Analise Monterosso, Meredith S Shiels

Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, 02118 USA Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, 20850 USA STD/HIV/Hepatitis Program; Louisiana Office of Public Health; Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana 70112 USA New York State Cancer Registry, New York State Department of Health, Albany, New York, 12202 USA MEd MPH. Maryland Cancer Registry, Maryland Department of Health, Baltimore, Maryland, 21215 USA Georgia Department of Health, Atlanta, Georgia 30303 USA Bureau of Communicable Disease Control, New York State Department of Health, Albany, New York, 12202 USA Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, Connecticut, 06134 USA Cancer Epidemiology Services, New Jersey Department of Health, Trenton, NJ, 08625-0369 USA Puerto Rico Central Cancer Registry, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico, 00936-8344 USA HIV/STD/HCV Epidemiology and Surveillance Branch, Department of State Health Services; Austin, TX 78714-9347 USA.
2021-5-28; doi: 10.1097/QAD.0000000000002962

Abstract

Objective

Recommendations for the age of initiating screening for cervical cancer in women living with HIV (WLHIV) in the United States have not changed since 1995 when all women (regardless of immune status) were screened for cervical cancer from the age of onset of sexual activity, which often occurs in adolescence. By 2009, recognizing the lack of benefit as well as harms in screening young women, guidelines were revised to initiate cervical cancer screening for the general population at age 21. By comparing cervical cancer incidence in young WLHIV to that of the general population, we assessed the potential for increasing the recommended age of initiating cervical cancer screening in WLHIV.

Design

We compared age-specific invasive cervical cancer (ICC) rates among WLHIV to the general population in the United States HIV/AIDS Cancer Match Study.

Methods

We estimated standardized incidence ratios as the observed number of cervical cancer cases among WLHIV divided by the expected number, standardized to the general population by age, race/ethnicity, registry and calendar year.

Results

ICC rates among WLHIV were elevated across all age groups between ages 25-54 (SIR=3.80; 95%CI 3.48, 4.15), but there were zero cases among ages <25.

Conclusions

The absence of ICC among WLHIV <25 years supports initiating cervical cancer screening at age 21, rather than adolescence, to prevent cancers in WLHIV at ages with higher risk of ICC.