Cancer Incidence and Cancer Screening Practices Among a Cohort of Persons Receiving HIV Care in Washington, DC

In this era of effective combination antiretroviral therapy the incidence of AIDS defining cancers (ADCs) is projected to decline while the incidence of certain non-AIDS defining cancers (NADCs) increases. Some of these NADCs are potentially preventable with appropriate cancer screening. We examined cancer incidence, screening eligibility, and receipt of screening among persons actively enrolled in the DC Cohort, a longitudinal observational cohort of PLWH, between 2011 and 2017. Cancer screening eligibility was determined based on age, sex, smoking history and co-morbidity data available and published national guidelines. The incidence rate of NADCs was 12.1 (95% CI 10.7, 13.8) and ADCs 1.6 (95% CI 0.6, 4.6) per 1000 person-years. The most common incident NADCs were breast 2.6 (95% CI 0.5,1 2.1), prostate 2.3 (95% CI 1.2, 4.3), and non-melanoma skin 1.2 (95% CI 0.6, 2.3) incident diagnoses/cases per 1000 person-years. Among cohort sites where receipt of cancer screening was assessed, less than 60% of eligible participants had any ascertained anal HPV, breast, cervical, colorectal, hepatocellular carcinoma, or lung cancer screening. In this cohort of PLWH, there were more incident NADCs versus ADCs in contrast to earlier cohort studies where ADCs predominated. Despite a large eligible population there were low rates of screening. Implementation of cancer screening is an important component of care among PLWH.