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Momplaisir F, Mounzer K, Long JA. Preventive cancer screening practices in HIV positive patients. Paper presented at: Society of General Internal Medicine Annual Meeting; 2012 May 10; Orlando, FL.
Background: With the wide spread use of antiretroviral therapy, patients with HIV are living longer and are at risk of developing non-AIDS Defining Malignancies. In this study we evaluate the rates of routine colorectal and breast cancer screening in patients with and without HIV and identify factors associated with cancer screening. Methods: Design: We performed a cross-sectional survey of patients willing to complete the study questionnaire in waiting rooms of three outpatient HIV clinics and one general internal medicine clinic in Philadelphia, Pennsylvania. The survey asked about basic demographics; their colorectal and breast cancer screening history; cancer risk; and presence of other chronic diseases. The HIV positive patients were given additional questions about their HIV disease and their HIV providers. HIV clinics were categorized as integrated (providing HIV and primary care) and non-integrated (providing only HIV care). Study population: Women with and without HIV age 40 and older and men with and without HIV age 50 and older who agreed to complete the survey. Outcome: Survey respondents were considered current for their colorectal cancer (CRC) screening if they reported having at least one colonoscopy during the past 10 years, a flexible sigmoidoscopy during the past five years, or fecal occult blood testing during the last year regardless of the reason for the test. Women were on target on their breast cancer screening if they reported having at least one mammogram during the past year regardless of the indication for the study. Results: 762 complete surveys were collected. 401 respondents were HIV positive. Patients with HIV were younger (mean age 54 versus 62, p < 0.001), mostly male (53.6% versus 30.5%, p < 0.001) black, non-Hispanic (62.8% versus 56.5%, p = 0.006) and low-income (62.8% versus 27.4%, p < 0.001). Co-morbidity counts were similar across both groups (0.76). Patients with HIV were less likely to be up-to-date with their routine cancer screening (45.6% versus 65%, p < 0.001 for CRC screening and 20.4% versus 62.3% p < 0.001 for breast cancer screening). After adjusting for demographic and clinical factors, the odds of up to date CRC screening were no longer significantly different between patients with and without HIV (OR 0.6; 95% CI 0.3-1.2); however, HIV positive women remained significantly less likely to be current with breast cancer screening (OR 0.1; 95% CI 0.0-0.2). HIV positive patients enrolled in the integrated and the non-integrated care clinics differed significantly: whites, males, high income and highly educated patients were more likely to attend the non-integrated care clinic. There was a trend toward decreased CRC screening and increased breast cancer screening in integrated care clinics but this finding did not reach statistical significance. Conclusions: Routine cancer screening needs to be improved in HIV positive patients. The integrated care clinic provides care to more disadvantaged HIV patients and is not associated with higher cancer screening rates. This could be secondary to non-adherence. It is also possible that patients in the integrated care clinic encounter competing priorities between HIV care and primary care during their visits in contrast to patients in the nonintegrated care clinic.