Table 1.

Cancer risk in HIV-infected persons compared to general population, estimated cancer incidence rates, proposed cancer screening modalities, and benefits and harms of respective screening tests

Cancer	cART era RR in HIV+	Estimated IR in HIV+ (per 100,000 p-y)a	Screening modalities	Benefit of screening test	Harms of screening test
Cervical	3.0–13 [18••, 20••]	24–293 [18••, 20••]	Pap testing	Sensitive, and detects treatable pre-cursor lesions and early cancers; mortality benefit inferred from ecological studies	Minimally invasive, low specificity, leading to false-positive tests
			HPV testing	Noninvasive but benefits unclear in HIV-infected patients	Low specificity, likely leading to false-positive tests
Anal	15–47 [18••, 37•]	111–130 [18••, 20••]	Anal Pap testing	Sensitive for premalignant lesions, impact on mortality unknown	Minimally invasive, low specificity, leading to false-positive tests
			HRA	Sensitive and specific for premalignant and malignant lesions, impact on mortality unknown.	Moderately invasive, not widely available
			DRE	Inexpensive, minimally invasive but diagnostic utility not studied	Sensitivity and specificity unknown, harms unquantified
Breast	0.64–0.90b [20••, 37•]	18 [20••]	Mammography	Mortality benefit from RCTs	False positives lead to unnecessary biopsies, psychological distress
Colorectal	1.2b [20••, 37•]	41 [20••]	FOBT	Mortality benefit from RCTs	False positives lead to moderately invasive testing
			Sigmoidoscopy	Mortality benefit in recent RCT	Moderately invasive, procedural complications
			Colonoscopy	Mortality benefit from observational data only, but highly likely	Moderately invasive, procedural complications
Liver	2.8–7.5 [18••, 37•]	26–98 [18••, 20••]	Ultrasonography	Mortality benefit shown in HBV mono-infection, inferred benefit in hepatitis co-infection with HIV	False-positive tests may lead to invasive biopsy, treatment options limited in non-transplant candidates
			AFP testing	Limited benefits	Limited sensitivity and specificity leading to false positives and false negatives
Prostate	0.56–1.0b [18••, 37•]	97–260 [18••, 20••]	PSA testing	Noninvasive with small or no mortality benefits seen in recent RCTs	Low specificity leading to excessive invasive testing and excess treatment
Lung	2.0–3.5 [18••, 37•]	64–288 [18••, 20••]	Low-dose chest CT	Early RCT data suggesting mortality benefit	Confirmatory testing is invasive, false positives may experience significant harms

^aUnadjusted incidence rates

^bNot statistically significant

AFP alpha-fetoprotein; cART combination antiretroviral therapy; DRE digital rectal examination; FOBT fecal occult blood testing; HBV hepatitis B virus; HPV human papilloma virus; HRA high-resolution anoscopy; IR incidence rate; PSA prostate-specific antigen; p-y person-year; RCT randomized control trial; RR relative risk