Racial disparities in stage at diagnosis of HIV–associated cancers: A SEER Analysis 2018-2022.

Abstract

e13733 Background: Cancer risk is increased in people living with HIV (PLWH), and malignancy forms a leading cause of morbidity and mortality in this population. Multiple cancers are known to be associated with HIV/AIDS, including NHL, Hodgkin Lymphoma, Kaposi Sarcoma and cancers of the genital tract. Concurrently, patients with HIV are known to have worse outcomes following a cancer diagnosis, partially due to inequities in receipt of treatment. In this study, we examined racial differences in stage at diagnosis of HIV-associated cancers, including comparing to Colorectal cancer, a cancer of significant incidence and established surveillance paradigms. Methods: We conducted a population-based cohort study of patients diagnosed with HIV-associated cancers in the United States. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) from 2018-2022. Age-adjusted incident rates (AAIRs) were calculated per 1,000,000 population for each race using the direct standardization method based on age group weights from the 2000 standard US population. Stage was defined by the Summary Stage 2018 categories. Distribution of stage at diagnosis within racial groups were calculated as percentages. Differences in stage distribution were assessed using the chi-square test, with effect size quantification using Cramér’s V. Multivariable logistic regression was performed to evaluate association between race and distant stage at diagnosis while adjusting for age, household income and rurality. Comparisons with colorectal cancer were based on published national stage distributions. Results: A total of 126,206 cancer cases were identified. Across all racial groups, the highest AAIRs were observed for distant disease, with greatest burden observed among Hispanic (5.94) and lowest among Asian/Pacific Islander patients (4.13). A substantial proportion of all racial groups presented with advanced disease at diagnosis (Hispanic 41.3%, White 43.8%, Black 40.9%, Asian or Pacific Islander 42.1%, American Indian/Alaska Native 42.1%). While on unadjusted analysis stage at diagnosis differed significantly by race (χ² = 216.5, df = 8, p < 0.001), the magnitude of association was small (Cramér’s V = 0.029), and after adjustment race was not found to be independently associated with distant stage disease at diagnosis (adjusted OR 1.02(0.99-1.04) p = 0.19). Conclusions: While race was not found to correlate with distant disease independently, almost half of our studied cancers were found to be advanced stage at diagnosis. In comparison, only 22.5% of colorectal cancer cases were advanced at diagnosis. It is possible that systemic and structural barriers may play a role in patients with cancers classically associated with HIV being unable to obtain timely care across all races. Tailored screening and surveillance programs may be warranted to promote earlier diagnosis of cancer among PLWH.