Cancer incidence is increasing but cancer survival is improving. The life expectancy of PLWHIV also increases with improved HAART, so it is to be expected that PLWHIV are likely to develop a second primitive cancer. It is known that the risk of second cancer is slightly higher after a first cancer and depends on several parameters: the location of the first cancer (the risk is higher after H&N, lung cancer or Hodgkin’s lymphoma) and environmental risk factors such as tobacco or alcohol intake but few studies are available nowadays on this subject. PLWHIV have a high risk of cancer: what for a second cancer incidence?
The files of 601 patients presented at the multidisciplinary meeting of the CANCERVIH network were reviewed. CANCERVIH is a national "rare cancers" network, accredited by the French National Cancer Institute. For all these patients, the history of cancer, indicated by the referring physicians, was examined. History of cancer that was neither metastasis nor locoregional relapse was considered a first primitive cancer. Cancers developing in the same location were considered as first primitive cancers only if they were considered in complete response at least 5 years before and no relapse was detected in the meantime.
Of the 601 patients reviewed, 72 (12%) had a history of at least one cancer. Fourteen (2,3%) patients had at least 2 previous cancers. For one it was his 7th cancer’s case. 2036PFirst cancer (number of patients) Number of secondary cancer(s) (number of patients) Kaposi (25) 1 (23) 2 (2) NHL (7) 1 (5) 2 (2) Anal canal (6) 1 (2) 2 (3) 3 (1) Prostate (6) 1 (4) 2 (1) 6 (1) Breast (5) 1 (5) Head and Neck (5) 1 (4) 4 (1) Hodgkin lymphoma (4) 1 (4) Kidney (4) 1 (3) 2 (1) Skin melanoma (3) 1 (2) 2 (1) Eye (2) 1 (1) 3 (1) Anal margin (1) 1 (1) Lung (1) 1 (1) Ovary (1) 1 (1) Large intestine (1) 2 (1) Liver (1) 1 (1)
In this study, the initial locations at risk of second cancer seems to concern primarily AIDS defining cancer and among the non-AIDS defining cancers, anal cancer appeared the first one ahead breast and head and neck cancers, showing the importance of maintaining permanent immuno-virological control in these patients’ population: such results confirm the need to maintain and emphasize prevention and screening programs in this high cancer risk population including for those with a sustained undetectable HIV viral load and/or immune restoration.
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