Yoanna S Pumpalova1, Oluwatosin A Ayeni2,3,4, Wenlong Carl Chen2,5,6, Daniel S O'Neil7, Sarah Nietz2,8, Boitumelo Phakathi2,8, Ines Buccimazza2,9, Sharon Čačala2,10, Laura W Stopforth2,10, Hayley A Farrow2,10, Maureen Joffe2,3,4, Witness Mapanga2,11, Judith S Jacobson12,13, Katherine D Crew1,12,13, Herbert Cubasch2,4,8, Paul Ruff2,4,11, Alfred I Neugut14,15,16,17. 1. Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. 2. Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa. 3. SAMRC/Wits Developmental Pathways To Health Research Unit, Department of Pediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 4. South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa. 5. National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa. 6. Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 7. Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA. 8. Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 9. Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa. 10. Departments of Surgery and Radiation Oncology, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa. 11. Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 12. Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. 13. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. 14. Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. ain1@columbia.edu. 15. Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. ain1@columbia.edu. 16. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. ain1@columbia.edu. 17. Division of Medical Oncology, Columbia University Irving Medical Center, 722 West 168th Street, Room 725, New York, NY, 10032, USA. ain1@columbia.edu.
Abstract
PURPOSE: Advanced breast cancer (BC) at diagnosis is common in sub-Saharan Africa (SSA), including among women living with HIV (WLWH). In public hospitals across South Africa (SA), 10-15% of women present with stage IV BC, compared to < 5% in the United States (US); 20% of new BC diagnoses in SA are in WLWH. We evaluated the impact of HIV on overall survival (OS) among women with stage IV BC. METHODS: We conducted a prospective cohort study of women diagnosed with stage IV BC between February 2, 2015 and September 18, 2019 at six public hospitals in SA. Multivariate Cox regression models were used to estimate the association between HIV status and OS. RESULTS: Among 550 eligible women, 147 (26.7%) were WLWH. Compared to HIV-negative BC patients, WLWH were younger (median age 45 vs. 60 years, p < 0.001), predominantly black (95.9% vs. 77.9%, p < 0.001), and more likely to have hormone receptor-negative (hormone-negative) BC (32.7% vs. 22.6%, p = 0.016). Most women received systemic cancer-directed therapy (80.1%). HIV status was not associated with treatment or OS (Hazard Ratio (HR) 1.13 [95%CI 0.89-1.44]). On exploratory subgroup analysis, WLWH and hormone-negative BC had shorter OS compared to HIV-uninfected women (1-year OS: 27.1% vs. 48.8%, p = 0.003; HR 1.94 [95%CI 1.27-2.94]; p = 0.002), which was not observed for hormone receptor-positive BC. CONCLUSION: HIV status was not associated with worse OS in women with stage IV BC in SA and cannot account for the poor survival in this cohort. Subgroup analysis revealed that WLWH with hormone-negative BC had worse OS, which warrants further investigation.
PURPOSE: Advanced breast cancer (BC) at diagnosis is common in sub-Saharan Africa (SSA), including among women living with HIV (WLWH). In public hospitals across South Africa (SA), 10-15% of women present with stage IV BC, compared to < 5% in the United States (US); 20% of new BC diagnoses in SA are in WLWH. We evaluated the impact of HIV on overall survival (OS) among women with stage IV BC. METHODS: We conducted a prospective cohort study of women diagnosed with stage IV BC between February 2, 2015 and September 18, 2019 at six public hospitals in SA. Multivariate Cox regression models were used to estimate the association between HIV status and OS. RESULTS: Among 550 eligible women, 147 (26.7%) were WLWH. Compared to HIV-negative BC patients, WLWH were younger (median age 45 vs. 60 years, p < 0.001), predominantly black (95.9% vs. 77.9%, p < 0.001), and more likely to have hormone receptor-negative (hormone-negative) BC (32.7% vs. 22.6%, p = 0.016). Most women received systemic cancer-directed therapy (80.1%). HIV status was not associated with treatment or OS (Hazard Ratio (HR) 1.13 [95%CI 0.89-1.44]). On exploratory subgroup analysis, WLWH and hormone-negative BC had shorter OS compared to HIV-uninfected women (1-year OS: 27.1% vs. 48.8%, p = 0.003; HR 1.94 [95%CI 1.27-2.94]; p = 0.002), which was not observed for hormone receptor-positive BC. CONCLUSION: HIV status was not associated with worse OS in women with stage IV BC in SA and cannot account for the poor survival in this cohort. Subgroup analysis revealed that WLWH with hormone-negative BC had worse OS, which warrants further investigation.
Authors: A O Adisa; O A Arowolo; A A Akinkuolie; N A Titiloye; O I Alatise; O O Lawal; A R K Adesunkanmi Journal: Afr Health Sci Date: 2011-06 Impact factor: 0.927
Authors: Herbert Cubasch; Paul Ruff; Maureen Joffe; Shane Norris; Tobias Chirwa; Sarah Nietz; Vinay Sharma; Raquel Duarte; Ines Buccimazza; Sharon Čačala; Laura W Stopforth; Wei-Yann Tsai; Eliezer Stavsky; Katherine D Crew; Judith S Jacobson; Alfred I Neugut Journal: J Glob Oncol Date: 2017-04
Authors: Oluwatosin A Ayeni; Daniel S O'Neil; Yoanna S Pumpalova; Wenlong Carl Chen; Sarah Nietz; Boitumelo Phakathi; Ines Buccimazza; Sharon Čačala; Laura W Stopforth; Hayley A Farrow; Witness Mapanga; Maureen Joffe; Tobias Chirwa; Valerie McCormack; Judith S Jacobson; Katherine D Crew; Alfred I Neugut; Paul Ruff; Herbert Cubasch Journal: Int J Cancer Date: 2022-03-04 Impact factor: 7.316