Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV

Breast Cancer Clinical Characteristics, Management, and Outcomes in Women Living With HIV/AIDS Globally: A Systematic Review and Meta-Analysis

Although associations between HIV and breast cancer (BC) have been investigated, the global literature remains inconsistent regarding clinical features and outcomes in HIV-positive patients. This study aims to clarify the clinicopathologic characteristics, management strategies, and survival in HIV-positive versus HIV-negative patients with BC. We searched PubMed, Scopus, and Cochrane Library for articles published until June 2023. We included observational studies presenting original data on tumor stage, receptor status, management, and survival in HIV-infected patients. We retrieved 5214 records and, after abstract and full-text screening, identified 17 papers that met inclusion criteria. Risk of bias and study quality were assessed with a modified Newcastle-Ottawa Scale. The I2 statistic was used to assess inter-study heterogeneity. Results were analyzed using a random-effects model. A total of 1201 HIV-positive and 4077 HIV-negative patients diagnosed with BC were identified. No significant differences in receptor status or stage at presentation were observed between the two groups in our pooled analysis. Management in HIV-positive patients was similar to HIV-negative for surgery (pooled odds ratio [pOR]: 1.43, 95% confidence interval [CI]: 0.82-2.04), radiation (pOR: 1.63, 95% CI 0.84-2.43), and chemotherapy (pOR: 1.27, 95% CI: 0.72-1.83). Despite presenting with similar clinicopathologic characteristics and management patterns as HIV-negative, HIV-positive patients had worse overall survival (pooled hazard ratio: 1.51, 95% CI: 1.21-1.88). Further research is needed to optimize treatment strategies and establish standardized guidelines for HIV-positive patients with BC, particularly in resource-limited settings where a high HIV burden and barriers to timely cancer care access may contribute to poor survival outcomes.

Patterns of breast cancer locoregional relapse, metastasis, and subtypes in Ghana

BACKGROUND

Significant advances have been made in targeted therapeutics and systemic therapy regimens for breast cancer (BC) treatment over the past decade. Tumour cells can however remain in the body, leading to locoregional relapse and/or metastasis. Subtypes of BC have distinct prognostic effects and have been linked to varying risks of early locoregional relapse and metastases, response to treatment, and overall survival. Most Low- and middle-income countries (LMICs) have no registries of BC locoregional relapse and metastasis.

METHODS

This study comprehensively reviewed, a 3-year retrospective single-centre data of female BC visiting the Komfo Anokye Teaching Hospital (KATH), Ghana to determine the prevalence of locoregional relapse and metastasis across our patient population. Prevalence of metastasis among the various BC subtypes was also determined.

RESULTS

Prevalence of BC locoregional relapse and metastasis were 3.4% and 47.6% respectively. For BC patients with documented locoregional relapse (N = 36), 27.8% (CI = 15.8 - 44.0%) had relapse to the contralateral breast, 41.7% (CI = 27.1 - 57.8%) had relapse to the ipsilateral breast, and 30.6% (CI = 18.0 - 46.9%) had relapse to regional lymph nodes. For BC patients with documented metastasis (N = 503), 151 (30%) had multiple organs involvement, 141 (28%) had lung metastases, 80 (16%) had bone metastases, 45 (9%) had liver metastases, 16 (3%) had brain metastases and 70 (14%) had other metastases (ovary, uterus, spleen, peritoneum, or distant lymph nodes). Basal subtype was the most common subtype (n = 82, 41%), followed by Luminal A (n = 69, 34.5%), HER2+ (n = 37, 18.5%) and Luminal B (n = 12, 6%). Basal subtypes had the most metastasis (35%), with multiple metastasis being the most prevalent (13%).

CONCLUSION

Close to half of the patients (46%) presented with metastatic BC. BC subtypes could influence the specific metastatic site. The most common BC subtype was the Basal subtype and had the most metastases (35%), with multiple metastasis being the most prevalent (13%). These findings should serve as a guide in the management of patients to enhance early prediction and detection of locoregional relapse and metastasis for improved overall treatment outcomes.

PAM50 breast cancer subtypes and survival of patients in rural Ethiopia without adjuvant treatment: a prospective observational study

PURPOSE

Survival rates of breast cancer (BC) patients are particularly low in rural regions in sub-Saharan Africa (SSA) which is due to limited access to therapy. In recent years, gene expression profiling (GEP) of BC showed a strong prognostic value in patients with local tumour surgery and (neo)adjuvant treatment. The aim of this study was to evaluate the impact of intrinsic subtypes on survival of patients in rural Ethiopia without any (neo)adjuvant therapy.

METHODS

In total, 113 female patients from Aira Hospital with histologically proven BC and treated only with surgery were included in this study. All samples were analysed by immunohistochemistry (IHC) for estrogen receptor, progesterone receptor, HER2 and Ki67, as well as RNA-expression analysis for PAM50 subtyping.

RESULTS

A positive hormone receptor status was found in 69.0% of the tumours and intrinsic subtyping demonstrated Luminal B to be the most common subtype (34.5%). Follow-up data was available for 79 of 113 patients. Two-year overall survival (OS) was 57.3% and a considerably worse OS was observed in patients with Basal-like BC compared to Luminal A BC. Moreover, advanced tumours showed an increased risk of mortality.

CONCLUSION

The OS was very low in the patient cohort that received no (neo)adjuvant treatment. Immunohistochemistry and GEP confirmed endocrine-sensitive tumours in more than half of the patients, with a large proportion of Luminal B, HER2-enriched and Basal-like tumours so that adjuvant chemotherapy should be recommended.

Quality of Life Gain Following Treatment Among Breast Cancer Survivors With and Without HIV

PURPOSE

Women living with HIV (WLWH) experience decreased breast cancer survival. We sought to determine whether WLWH surviving breast cancer also experienced different quality of life (QOL) gain.

METHODS

Women who enrolled in the Thabatse Cancer Cohort across oncology centers in Botswana for the initial treatment of stage I-III breast cancer from October 2010 to February 2022 were included. Exclusion criteria were no documented definitive therapy and incomplete data at treatment end or 24 ± 3 months after treatment. QOL was measured quarterly using the SF-8 questionnaire. G methods using weighted exposure and outcome modules were used to mitigate potential bias from imbalances in demographic and cancer characteristics by HIV status. Primary analysis was change in physical component summary (PCS) and mental component summary (MCS) from treatment end to 24 months after treatment for WLWH compared with women without HIV.

RESULTS

Of 603 women enrolled, the final analysis included 298, comprising 85 WLWH and 213 women without HIV. Most common reasons for exclusion were no documented definitive treatment (n = 114) and death before 21 months after treatment (n = 137). WLWH were younger, were less wealthy, and had more estrogen receptor/progesterone receptor positive tumors. Overall, PCS and MCS significantly increased from treatment end to 24 months after treatment, from 50.8 to 52.8 and 51.8 to 53.7, respectively. There was no difference in the change of the PCS or MCS with HIV infection, 2.2 (95% CI, -0.4 to 4.9) and 0.6 (95% CI, -1.7 to 2.9), respectively.

CONCLUSION

HIV infection did not impede QOL gain at 24 months after treatment in women surviving breast cancer. Further work is needed to clarify the role of HIV on specific treatment-related morbidities and in other malignancies.

Breast cancer in women by HIV status: A report from the South African National Cancer Registry

BACKGROUND

Breast cancer (BC) is the leading cause of cancer-related morbidity and mortality in women living in South Africa, a country with a high HIV burden. However, characteristics of the double burden of HIV and BC in South Africa have not been properly investigated. We described characteristics of BC cases by HIV status in South Africa.

METHODS

In this nationwide South African study, we obtained BC records for women aged ≥15 years diagnosed in the public health sector between January 2004 and December 2014. We included records from the National Cancer Registry that had been linked to HIV-related laboratory records from the National Health Laboratory Service. We assessed the odds of being HIV positive versus HIV negative in relation to patient-, cancer-, and municipality-related characteristics.

RESULTS

From 2004-2014, 40 520 BC cases were diagnosed in women aged ≥15 years. Of these, 73.5% had unknown HIV status, 18.7% were HIV negative, and 7.7% were HIV positive. The median age at BC diagnosis was 43 years (interquartile range [IQR]: 37-52) in HIV positive and 57 years (IQR: 46-68) in HIV negative women, respectively. The odds of being HIV positive was higher for women who were aged 30-34 years compared to women aged 35-39 years at cancer diagnosis (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.10-1.71), Black versus non-Black (OR 6.41, 95% CI 5.68-7.23), diagnosed with cancer in rural versus urban areas (OR 1.59, 95% CI 1.40-1.82) and diagnosed in municipalities with low and middle (OR 3.46, 95% CI 2.48-4.82) versus high socioeconomic position (OR 2.69, 95% CI 2.11-3.42).

CONCLUSION

HIV status was unknown for the majority of BC patients. Among those with known HIV status, being HIV positive was associated with a younger age at cancer diagnosis, being Black and receiving care in municipalities of poor socioeconomic position. Future studies should examine opportunities to integrate HIV and BC control programs.

PAM50 intrinsic subtypes, risk of recurrence score and breast cancer survival in HIV-positive and HIV-negative patients-a South African cohort study

PURPOSE

Treatment decision making for patients with breast cancer increasingly depends on analysis of markers or systems for estimating risk of breast cancer recurrence. Breast cancer intrinsic subtypes and risk of recurrence (ROR) scores have been found to be valuable in predicting survival and determining optimal treatment for individual patients. We studied the association of breast cancer survival with the PAM50 gene expression assay in HIV-positive and HIV-negative patients.

METHOD

RNA was extracted from formalin-fixed paraffin-embedded specimens of histologically confirmed invasive carcinoma and was purified using the AllPrep® DNA/RNA FFPE kit, Qiagen (Hilden, Germany). The NanoString RUO PAM50 algorithm was used to determine the molecular subtype and the risk of recurrence score of each sample. The overall and disease-free survival were determined with comparison made among HIV-positive and -negative patients. We then generated Kaplan-Meier survival curves, calculated p-values and estimated hazard ratios and their 95% confidence intervals using Cox regression models.

RESULTS

Of the 384 RNA samples analysed, 98.4% met the required RNA quality standard and the specified QC threshold for the test. Luminal B was the most common PAM50 intrinsic subtype and 82.1% of patients were at high risk for disease recurrence based on ROR score. HIV infection, PAM50-based HER2-enriched and basal-like intrinsic subtypes, and high ROR were associated with poor overall and disease-free survival. HIV-positive patients with luminal A & B subtypes had significantly worse survival outcomes than HIV-negative luminal patents.

CONCLUSION

Aggressive tumour biology was common in our cohort. HIV infection, PAM50 HER2-enriched,basal-like intrinsic subtypes and high ROR score were associated with poor overall and disease-free survival. HIV infection impacted survival in patients with luminal subtypes only.

Survival in HIV+ and HIV− women with breast cancer treated at the National Cancer Institute in the city of Rio de Janeiro, Brazil, between 2000 and 2014

Background: The goal was to assess the survival of HIV+ women and HIV- women for breast cancer at a referral center for cancer treatment in Brazil.

Methods: A retrospective cohort study was performed. A total of 136 women patients with breast cancer were included, being 36 HIV+ women and 100 HIV- women. Controls (HIV-) were selected according to HIV status, matched by date of cancer diagnosis, clinical stage, breast cancer treatment, and date of birth. Sociodemographic and cancer treatment data, as well as clinical HIV data, were extracted from physical and electronic medical records and secondary Instituto Nacional of cancer databases. To estimate survival, the Kaplan-Meier method was used. To determine the factors associated with mortality, Cox regression were used.

Results: The mean age of patients at diagnosis of cancer was 52 years. Regarding marital status, HIV+ patients had a higher frequency of single status). There were 44.1% deaths that occurred during the study period. Among HIV+ patients, there were 16 deaths, 15 of which were due to cancer. In HIV- patients there were 44 deaths (44%), with 32 cancer as the cause of death and 12 due to other causes. For the analysis of Overall. Differences were found in overall survival at 60 months (p=0.026), 55% and 69% respectively. The increased risk of death at 60 months among HIV+ women was observed also, after adjusting for schooling and molecular subtype (HR=1.95; 95% CI 1.03 – 3.70; p=0.041).

Conclusion: HIV infection influenced a worse prognosis for women with breast cancer regardless of tumor factors.

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HIV infection plays an important role in the prognosis of breast cancer.

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Matching of HIV+ and HIV− patients for important breast cancer characteristics.

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HIV+ patients exhibit worse overall survival when compared to HIV− patients.

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Cancer patients should undergo appropriate HAART regimens.

A Review of the Nucleic Acid-Based Lateral Flow Assay for Detection of Breast Cancer from Circulating Biomarkers at a Point-of-Care in Low Income Countries

The current levels of breast cancer in African women have contributed to the high mortality rates among them. In South Africa, the incidence of breast cancer is also on the rise due to changes in behavioural and biological risk factors. Such low survival rates can be attributed to the late diagnosis of the disease due to a lack of access and the high costs of the current diagnostic tools. Breast cancer is asymptomatic at early stages, which is the best time to detect it and intervene to prevent high mortality rates. Proper risk assessment, campaigns, and access to adequate healthcare need to be prioritised among patients at an early stage. Early detection of breast cancer can significantly improve the survival rate of breast cancer patients, since therapeutic strategies are more effective at this stage. Early detection of breast cancer can be achieved by developing devices that are simple, sensitive, low-cost, and employed at point-of-care (POC), especially in low-income countries (LICs). Nucleic-acid-based lateral flow assays (NABLFAs) that combine molecular detection with the immunochemical visualisation principles, have recently emerged as tools for disease diagnosis, even for low biomarker concentrations. Detection of circulating genetic biomarkers in non-invasively collected biological fluids with NABLFAs presents an appealing and suitable method for POC testing in resource-limited regions and/or LICs. Diagnosis of breast cancer at an early stage will improve the survival rates of the patients. This review covers the analysis of the current state of NABLFA technologies used in developing countries to reduce the scourge of breast cancer.