|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 22, No 7 (April 1), 2004: pp. 1347-1348 © 2004 American Society of Clinical Oncology. DOI: 10.1200/JCO.2004.99.261
Reasons for a Deficit of Breast Cancer Among HIV-Infected PatientsDepartments of Pathology and Medicine, Hematology-Oncology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA To the Editor: We read with interest the recent article by Herida et al1 in which they report on the incidence of non-AIDS-defining malignancies before and during the highly active antiretroviral era in France. The authors note that the incidence of breast cancer in HIV-infected women (but not men) in their study population, during both periods, was significantly lower compared with the French general population.1 This finding is surprising, since HIV-infection generally results in an increased susceptibility to neoplasia by means of a decreased immunologic response to tumor cells and an increased susceptibility to oncogenic viruses. Nevertheless, this deficit of breast cancer among HIV-infected individuals has been reported by other investigators from both African and Western countries.2-3 In fact, to date, only 46 published cases of breast cancer in HIV-positive individuals have been identified.4-6 In their article, Herida et al1 hypothesize that underreporting, or possible competing mortality, best explains this observed decrease in HIV-associated breast cancer. We disagree with their hypothesis, and suggest that there may be other factors at play. The apparent deficit of breast cancer among females in the Women's Interagency HIV Study, including 2,058 seropositive women, was explained by their overall lower risk (lower social class, early age at first childbirth, high parity, and low alcohol intake).7 Furthermore, one cannot entirely eliminate the possibility that immunodeficiency may protect HIV-infected persons from developing breast cancer.8-9 Analyses of cancer incidence in chronically immunosuppressed transplant recipients have demonstrated a similar unexpected low incidence of breast cancer relative to other malignancies.10 Furthermore, substantial information exists showing that a brisk immune response to some (not medullary) breast tumors correlates with a poor prognosis.11 Anticipated studies that generate a steadfast explanation for the mysterious deficit of breast cancer in the HIV-positive population may optimistically offer new pathogenesis-based treatments for breast cancer. Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES
1. Herida M, Mary-Krause M, Kaphan R, et al: Incidence of non–AIDS-defining cancers before and during the highly active antiretroviral therapy era in a cohort of human immunodeficiency virus–infected patients. J Clin Oncol 21:3447-3453, 2003 2. Amir H, Kaaya EE, Kwesigabo G, et al: Breast cancer before and during the AIDS epidemic in women and men: A study of Tanzanian Cancer Registry Data 1968 to 1996. J Natl Med Assoc 92:301-305, 2000[Medline]
3. Pantanowitz L, Dezube BJ: Breast cancer in women with HIV/AIDS. JAMA 285:3090-3091, 2001 4. Pantanowitz L, Connolly JL: Pathology of the breast associated with HIV/AIDS. Breast J 8:234-243, 2002[CrossRef][Medline] 5. Pantanowitz L, Dezube BJ: Breast cancer in HIV positive women: A report of four cases and review of the literature. Cancer Invest 21:665, 2003[Medline] 6. Guth AA: Breast cancer and human immunodeficiency virus infection: Issues for the 21st century. J Womens Health 12:227-232, 2003 7. Preston-Martin S, Seaberg J, Orenstein J, et al: Breast cancer among HIV-infected women: Findings from the Women's Interagency HIV Study (WIHS). Presented at 7th International Conference on Malignancies in AIDS and Other Immunodeficiencies, Bethesda, Maryland, April 28-29, 2003 8. Head JF, Elliott RL, McCoy JL: Evaluation of lymphocyte immunity in breast cancer patients. Breast Cancer Res Treat 26:77-88, 1993[CrossRef][Medline] 9. Pantanowitz L: Breast cancer and AIDS. J Natl Med Assoc 93:40-41, 2001[Medline] 10. Stewart T, Tsai SC, Grayson H, et al: Incidence of de-novo breast cancer in women chronically immunosuppressed after organ transplantation. Lancet 346:796-798, 1995[CrossRef][Medline] 11. O'Sullivan C, Lewis CE: Tumor-associated leucocytes: Friends or foes in breast carcinoma. J Pathol 172:229-235, 1994[CrossRef][Medline]
Related Article
Related Correspondence
Related Reply
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2004 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
