Stomach, Esophageal Cancer Risks Increased in AIDS Patients



ORLANDO – People with AIDS have a substantially increased risk of developing stomach and esophageal malignancies, compared with the general public, according to an analysis of data from the large, population-based HIV/AIDS Cancer Match Study.

Among the more than 600,000 people with AIDS who were included in the analysis, 1,166 developed stomach malignancies and 240 developed esophageal malignancies. The overall risks of stomach and esophageal malignancies were 6.9-fold and 2.7-fold higher, respectively, than in the general population, E. Christina Persson, Ph.D., reported at the annual meeting of the American Association for Cancer Research.

Although most of the increased risk was attributable to lymphomas, the risk of carcinomas was also increased. The lymphomas were not surprising, as AIDS patients are known to be at increased risk for these cancers, but the greater risk for carcinomas is a new finding, Dr. Persson said.

People with AIDS who were included in the HIV/AIDS Cancer Match Study (a linkage of 15 U.S. population–based HIV/AIDS and cancer registries) were registered in 1980-2007. This population is known to have a higher prevalence of cancer risk factors, as well an increased risk of infection-related malignancies resulting from a suppressed immune system. As AIDS therapies – and thus, survival - have improved, concern regarding cancer risk is increased.

In the current study, the risk of stomach carcinomas was increased 70% (standardized incidence ratio, 1.7), whereas the risk of stomach lymphomas was 36-fold higher. Similar increases in risk were seen for proximal (cardia) and distal (noncardia) carcinomas (SIR, 1.5 and 1.8, respectively), said Dr. Persson, a postdoctoral fellow at the National Cancer Institute.

The risk for esophageal carcinomas was increased 80% (SIR, 1.8), with a 54% increased risk of squamous cell carcinomas and a 101% increased risk for adenocarcinomas (SIR, 1.5 and 2.0), whereas there was a 261-fold increased risk of esophageal lymphomas, she said.

Dr. Judy E. Garber, the new AACR president and moderator of the press briefing where Dr. Persson discussed her findings, said the report is both fascinating and worrisome.

Given that most AIDS-related cancers are lymphomas, it is "quite remarkable to show solid tumor differences" in the AIDS population vs. the general public, she said, adding that she hopes this is not an indication that people who are surviving AIDS thanks to better treatments will have other problems, such as increased cancer risks, to contend with.

Although the findings do not warrant routine screening for solid tumors in the AIDS population at this time, this increased risk is something for clinicians to keep in mind when they care for AIDS survivors, said Dr. Garber, director of the center for cancer genetics and prevention at the Dana-Farber Cancer Institute, Boston.

Dr. Persson had no disclosures.

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