Cancer Screening

Cancer Screening Methods

(i)

Anal cancer

Person

MSM and persons with HPV-associated dysplasia(ii)

Procedure Digital rectal exam ± anal cytology
Evidence of benefit Unknown, advocated by some experts
Screening interval 1-3 years
Comments If anal cytology abnormal, perform anoscopy

Breast cancer

Person Women 50-70 years
Procedure Mammography
Evidence of benefit ↓ Breast cancer mortality
Screening interval 1-3 years

Cervical cancer

Person

Women living with HIV > 21 years

Procedure PAP smear or liquid based cervical cytology test
Evidence of benefit ↓ Cervical cancer mortality
Screening interval 1-3 years
Comments

HPV genotype testing may aid PAP/liquid based cervical screening

Colorectal cancer

Person

Persons 50-80 years with a life expectancy > 10 years

Procedure

Faecal occult blood test annually or sigmoidoscopy every 5 years or colonoscopy every 10 years

Evidence of benefit ↓ Colorectal cancer mortality
Screening interval 1-3 years

HepatoCellular Carcinoma (HCC)

Person

Persons with HCV and HBV with cirrhosis & in HBV-positive non-cirrhotics, HCC screening should follow current EASL guidelines*(iii)

Procedure Ultrasound (and alphafoetoprotein)
Evidence of benefit Earlier diagnosis allowing for improved ability for surgical eradication
Screening interval Every 6 months
Comments

* Risk factors for HCC in this population include family history of HCC, ethnicity (Asians, Africans), HDV and age > 45 years. EASL guidelines propose using the PAGE-B score in Caucasians to assess the HCC risk, however this score has not been validated in PLWH

See Liver Cirrhosis: Management and Viral Hepatitis Co-infection in PLWH

Prostate cancer

Person

Men > 50 years with a life expectancy >10 years

Procedure

PSA(iv)

Evidence of benefit Use of PSA is controversial
Screening interval 2-4 years
Comments Pros: ↑ early diagnosis and modest ↓ prostate cancer specific mortality.
Cons: overtreatment, adverse effects of treatment on quality of life

 

  1. Screening recommendations derived from the general population. These screenings should preferably be done as part of national general population-screening programmes. Careful examination of skin should be performed regularly to detect cancers such as Kaposi’s sarcoma, basal cell carcinoma and malignant melanoma
  2. Includes Anal Intraepithelial Neoplasia (AIN), Penile Intraepithelial Neoplasia (PIN), Cervical Intraepithelial Neoplasia (CIN), Vaginal Intraepithelial Neoplasia (VAIN) and Vulval Intraepithelial Neoplasia (VIN)
  3. HCC screening is indicated in all cirrhotic HBV or HCV co-infected persons (even if HCV infection has been cured and HBV replication is medically suppressed) in a setting where treatment for HCC is available. Although the cost-effectiveness of HCC screening in persons with F3 fibrosis is uncertain, surveillance may be con-sidered based on an individual risk assessment (https://easl.eu/publication/easl-clinical-practice-guidelines-management-of-hepatocellular-carcinoma/). In HBV-positive non-cirrhotics, HCC screening should follow current EASL guidelines. Risk factors for HCC in this population include family history of HCC, ethnicity (Asians, Africans), HDV and age > 45 years. EASL guidelines propose using the PAGE-B score in Caucasians to assess the HCC risk, however this score has not been validated in PLWH, see Liver Cirrhosis: Management and Viral Hepatitis Co-infection in PLWH
  4. Whilst prostate cancer screening with PSA can reduce prostate cancer specific mortality, the absolute risk reduction is very small. Given limitations in the design and reporting of the randomized trials, there remain important concerns that the benefits of screening are outweighed by the potential harms to quality of life, including the substantial risks for over-diagnosis and treatment complications
    See online video lectures Epidemiology of cancers and HIV-Part 1, Epidemiology of cancers and HIV-Part 2, Clinical Management of cancers and HIV-Part 1 and Clinical Management of cancers and HIV-Part 2 from the EACS online course Clinical Management of HIV