Racial Disparities in Anal Cancer Screening Among Men Living With HIV: Findings From a Clinical Cohort Study.
Adult
Aged
Alphapapillomavirus
Anal Canal
/ diagnostic imaging
Anus Neoplasms
/ complications
Cohort Studies
Cross-Sectional Studies
Early Detection of Cancer
/ methods
HIV Infections
/ complications
Homosexuality, Male
/ statistics & numerical data
Humans
Logistic Models
Male
Middle Aged
Ontario
/ epidemiology
Papillomavirus Infections
/ complications
Proctoscopy
Risk Factors
Sexual Behavior
Sexual and Gender Minorities
/ statistics & numerical data
Surveys and Questionnaires
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 07 2020
01 07 2020
Historique:
pubmed:
26
2
2020
medline:
5
1
2021
entrez:
26
2
2020
Statut:
ppublish
Résumé
Our objective was to quantify the extent of anal cancer screening among men receiving HIV specialty care in Ontario, Canada, and evaluate factors associated with screening. Cross-sectional questionnaire within a multisite clinical HIV cohort. A questionnaire assessing knowledge and experience with human papillomavirus-associated diseases and their prevention was administered in 2016-2017 to 1677 men in the Ontario HIV Treatment Network Cohort Study. We used logistic regression to identify factors associated with having discussed screening with a health care provider and self-reported receipt of screening [digital anal rectal examinations (DARE); anal cytology or anoscopy]. Results reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Forty percent of men reported ever having had anal cytology/anoscopy, and 70% had ever had DARE. After accounting for differences in age, sexual orientation, years since HIV diagnosis, previous diagnosis with AIDS, knowing someone with human papillomavirus-associated cancer, comfort discussing anal health, education, and income, the proportion screened differed by self-identified race. Compared with white men, Asian men were less likely to have discussed screening with a health care provider (aOR = 0.48; 95% CI: 0.29 to 0.80) or to have been screened by DARE (aOR = 0.27; 95% CI: 0.17 to 0.44) or anal cytology/anoscopy (aOR = 0.51; 95% CI: 0.31 to 0.83), and African, Caribbean, or black men (aOR = 0.47; 95% CI: 0.31 to 0.70) were less likely to have had DARE. Results were consistent when restricting the analyses to gay, bisexual, and other men who have sex with men. Our findings highlight the potential for disparities in anal cancer screening that need to be considered when developing guidelines and screening programs to reduce the burden of anal cancer among men living with HIV and ensure health equity.
Sections du résumé
BACKGROUND
Our objective was to quantify the extent of anal cancer screening among men receiving HIV specialty care in Ontario, Canada, and evaluate factors associated with screening.
SETTING
Cross-sectional questionnaire within a multisite clinical HIV cohort.
METHODS
A questionnaire assessing knowledge and experience with human papillomavirus-associated diseases and their prevention was administered in 2016-2017 to 1677 men in the Ontario HIV Treatment Network Cohort Study. We used logistic regression to identify factors associated with having discussed screening with a health care provider and self-reported receipt of screening [digital anal rectal examinations (DARE); anal cytology or anoscopy]. Results reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
RESULTS
Forty percent of men reported ever having had anal cytology/anoscopy, and 70% had ever had DARE. After accounting for differences in age, sexual orientation, years since HIV diagnosis, previous diagnosis with AIDS, knowing someone with human papillomavirus-associated cancer, comfort discussing anal health, education, and income, the proportion screened differed by self-identified race. Compared with white men, Asian men were less likely to have discussed screening with a health care provider (aOR = 0.48; 95% CI: 0.29 to 0.80) or to have been screened by DARE (aOR = 0.27; 95% CI: 0.17 to 0.44) or anal cytology/anoscopy (aOR = 0.51; 95% CI: 0.31 to 0.83), and African, Caribbean, or black men (aOR = 0.47; 95% CI: 0.31 to 0.70) were less likely to have had DARE. Results were consistent when restricting the analyses to gay, bisexual, and other men who have sex with men.
CONCLUSION
Our findings highlight the potential for disparities in anal cancer screening that need to be considered when developing guidelines and screening programs to reduce the burden of anal cancer among men living with HIV and ensure health equity.
Identifiants
pubmed: 32097251
doi: 10.1097/QAI.0000000000002335
pii: 00126334-202007010-00009
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
295-303Subventions
Organisme : CIHR
Pays : Canada
Références
Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8:e81355.
Kennedy BJ. Aging and cancer. J Clin Oncol. 1988;6:1903–1911.
Burchell AN, Raboud J, Donelle J, et al. Cause-specific mortality among HIV-infected people in Ontario, 1995-2014: a population-based retrospective cohort study. CMAJ Open. 2019;7:E1–E7.
Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370:59–67.
Coghill AE, Shiels MS, Suneja G, et al. Elevated cancer-specific mortality among HIV-infected patients in the United States. J Clin Oncol. 2015;33:2376–2383.
Marcus JL, Chao C, Leyden WA, et al. Survival among HIV-infected and HIV-uninfected individuals with common non-AIDS-defining cancers. Cancer Epidemiol Biomarkers Prev. 2015;24:1167–1173.
Althoff KN, McGinnis KA, Wyatt CM, et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin Infect Dis. 2015;60:627–638.
Brickman C, Palefsky JM. Cancer in the HIV-infected host: epidemiology and pathogenesis in the antiretroviral era. Curr HIV/AIDS Rep. 2015;12:388–396.
Piketty C, Selinger-Leneman H, Bouvier AM, et al. Incidence of HIV-related anal cancer remains increased despite long-term combined antiretroviral treatment: results from the French hospital database on HIV. J Clin Oncol. 2012;30:4360–4366.
Silverberg MJ, Chao C, Leyden WA, et al. HIV infection and the risk of cancers with and without a known infectious cause. AIDS. 2009;23:2337–2345.
Silverberg MJ, Lau B, Justice AC, et al. Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clin Infect Dis. 2012;54:1026–1034.
Silverberg MJ, Lau B, Achenbach CJ, et al. Cumulative incidence of cancer among persons with HIV in North America: a cohort study. Ann Intern Med. 2015;163:507–518.
Palefsky JM. Human papillomavirus-associated anal and cervical cancers in HIV-infected individuals: incidence and prevention in the antiretroviral therapy era. Curr Opin HIV AIDS. 2017;12:26–30.
Brickman C, Palefsky JM. Human papillomavirus in the HIV-infected host: epidemiology and pathogenesis in the antiretroviral era. Curr HIV/AIDS Rep. 2015;12:6–15.
Darragh TM, Winkler B. Anal cancer and cervical cancer screening: key differences. Cancer Cytopathol. 2011;119:5–19.
Berry JM, Palefsky JM, Jay N, et al. Performance characteristics of anal cytology and human papillomavirus testing in patients with high-resolution anoscopy-guided biopsy of high-grade anal intraepithelial neoplasia. Dis Colon Rectum. 2009;52:239–247.
Hillman RJ, Cuming T, Darragh T, et al. 2016 IANS international guidelines for practice standards in the detection of anal cancer precursors. J Low Genit Tract Dis. 2016;20:283–291.
Hillman RJ, Berry-Lawhorn JM, Ong JJ, et al. International anal neoplasia society guidelines for the practice of digital anal rectal examination. J Low Genit Tract Dis. 2019;23:138–146.
Russo S, McCaffery K, Ellard J, et al. Experience and psychological impact of anal cancer screening in gay, bisexual and other men who have sex with men: a qualitative study. Psychooncology. 2018;27:125–131.
Lam JO, Barnell GM, Merchant M, et al. Acceptability of high-resolution anoscopy for anal cancer screening in HIV-infected patients. HIV Med. 2018;19:716–723.
Landstra JM, Ciarrochi J, Deane FP, et al. The psychological impact of anal cancer screening on HIV-infected men. Psychooncology. 2013;22:614–620.
D'Souza G, Rajan SD, Bhatia R, et al. Uptake and predictors of anal cancer screening in men who have sex with men. Am J Public Health. 2013;103:e88–95.
Wells JS, Holstad MM, Watkins Bruner D. Sociodemographic predictors of anal cancer screening and follow-up in human immunodeficiency virus-infected individuals. Cancer Nurs. 2018;41:424–430.
Hicks JT, Hwang LY, Baraniuk S, et al. Factors associated with self-reported anal cancer screening history in men who have sex with men. Sex Health. 2018;16:96–98.
D'Souza G, Wiley DJ, Li X, et al. Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 2008;48:491–499.
Jerant AF, Fenton JJ, Franks P. Determinants of racial/ethnic colorectal cancer screening disparities. Arch Intern Med. 2008;168:1317–1324.
Goel MS, Wee CC, McCarthy EP, et al. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med. 2003;18:1028–1035.
Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54:78–93.
Lofters AK, Hwang SW, Moineddin R, et al. Cervical cancer screening among urban immigrants by region of origin: a population-based cohort study. Prev Med. 2010;51:509–516.
Wang AMQ, Yung EM, Nitti N, et al. Breast and colorectal cancer screening barriers among immigrants and refugees: a mixed-methods study at three community health centres in Toronto, Canada. J Immigr Minor Health. 2019;21:473–482.
Cooper RS, Nadkarni GN, Ogedegbe G. Race, ancestry, and reporting in medical journals. JAMA. 2018;320:1531–1532.
Lofters AK. Ethnicity and breast cancer stage at diagnosis: an issue of health equity. Curr Oncol. 2015;22:80–81.
Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40:105–125.
Walsh T, Bertozzi-Villa C, Schneider JA. Systematic review of racial disparities in human papillomavirus-associated anal dysplasia and anal cancer among men who have sex with men. Am J Public Health. 2015;105:e34–45.
Rourke SB, Gardner S, Burchell AN, et al. Cohort profile: the Ontario HIV Treatment Network Cohort Study (OCS). Int J Epidemiol. 2013;42:402–411.
Ogilvie G, Anderson M, Marra F, et al. A population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada: parental factors associated with HPV vaccine receipt. PLoS Med. 2010;7:e1000270.
Salit IE, Blitz S, Collins E, et al. Anal cancer screening in HIV primary care: uptake and outcomes. Sex Health. 2013;10:588.
Burchell AN, Tellier PP, Hanley J, et al. Influence of partner's infection status on prevalent human papillomavirus among persons with a new sex partner. Sex Transm Dis. 2010;37:34–40.
Burchell AN, Coutlee F, Tellier PP, et al. Genital transmission of human papillomavirus in recently formed heterosexual couples. J Infect Dis. 2011;204:1723–1729.
Ogilvie GS, Remple VP, Marra F, et al. Parental intention to have daughters receive the human papillomavirus vaccine. CMAJ. 2007;177:1506–1512.
Ziarnowski KL, Brewer NT, Weber B. Present choices, future outcomes: anticipated regret and HPV vaccination. Prev Med. 2009;48:411–414.
Wheldon CW, Daley EM, Buhi ER, et al. Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the Southeastern United States. Vaccine. 2011;29:8060–8065.
Ong JJ, Chen M, Grulich A, et al. Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia. J Int AIDS Soc. 2015;18:19895.
Massad LS, Evans CT, Weber KM, et al. Changes in knowledge of cervical cancer following introduction of human papillomavirus vaccine among women at high risk for cervical cancer. Gynecol Oncol Rep. 2015;12:37–40.
Cummings T, Kasting ML, Rosenberger JG, et al. Catching up or missing out? Human papillomavirus vaccine acceptability among 18- to 26-year-old men who have sex with men in a US national sample. Sex Transm Dis. 2015;42:601–606.
Hughes J, Cates JR, Liddon N, et al. Disparities in how parents are learning about the human papillomavirus vaccine. Cancer Epidemiol Biomarkers Prev. 2009;18:363–372.
Gerend MA, Shepherd JE. Predicting human papillomavirus vaccine uptake in young adult women: comparing the health belief model and theory of planned behavior. Ann Behav Med. 2012;44:171–180.
Askelson NM, Campo S, Lowe JB, et al. Using the theory of planned behavior to predict mothers' intentions to vaccinate their daughters against HPV. J Sch Nurs. 2010;26:194–202.
Salit I. The HPV-SAVE Study Team: HPV Screening, Ablation, and Vaccine Evaluation in Men Who Have Sex With Men (HPV-SAVE). 2015; Available at: https://clinicaltrials.gov/ct2/show/study/NCT02503111. Accessed March 5, 2017.
Gaspar M, Grennan T, Salit I, et al. Confronting comorbidity risks within HIV biographies: gay men's integration of HPV-associated anal cancer risk into their narratives of living with HIV. Health Risk Soc. 2018;20:276–296.
Bassett MT, Graves JD. Uprooting institutionalized racism as public health practice. Am J Public Health. 2018;108:457–458.
Ahmed S, Shahid RK. Disparity in cancer care: a Canadian perspective. Curr Oncol. 2012;19:e376–382.
Bradby H. Race, ethnicity and health: the costs and benefits of conceptualising racism and ethnicity. Soc Sci Med. 2012;75:955–958.
Newman PA, Roberts KJ, Masongsong E, et al. Anal cancer screening: barriers and facilitators among ethnically diverse gay, bisexual, transgender, and other men who have sex with men. J Gay Lesbian Soc Serv. 2008;20:328–353.
Koskan AM, LeBlanc N, Rosa-Cunha I. Exploring the perceptions of anal cancer screening and behaviors among gay and bisexual men infected with HIV. Cancer Control. 2016;23:52–58.
Grace D, Gaspar M, Paquette R, et al. HIV-positive gay men's knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: a qualitative study. PLoS One. 2018;13:e0207953.
Peterson EB, Ostroff JS, DuHamel KN, et al. Impact of provider-patient communication on cancer screening adherence: a systematic review. Prev Med. 2016;93:96–105.
Gaspar M, Rosenes R, Burchell A, et al. Diagnosing uncertainty: the challenges of implementing medical screening programs for minority sub-populations in Canada. Soc Sci Med. 2019;244:112643.
Salit IE, Lytwyn A, Raboud J, et al. The role of cytology (Pap tests) and human papillomavirus testing in anal cancer screening. AIDS. 2010;24:1307–1313.
Weiss ES. Feasibility of screening for anal cancer in HIV-positive people older than 50 years in Canada. CMAJ. 2019;191:E171.
Grace D, Gaspar M, Rosenes R, et al. Economic barriers, evidentiary gaps, and ethical conundrums: a qualitative study of physicians' challenges recommending HPV vaccination to older gay, bisexual, and other men who have sex with men. Int J Equity Health. 2019;18:159.