Cervical cancer incidence stratified by age in women with HIV compared with the general population in the United States, 2002–2016
Recommendations for the age of initiating screening for cervical cancer in women living with HIV (WLHIV) in the United States have not changed since 1995 when all women (regardless of immune status) were screened for cervical cancer from the age of onset of sexual activity, which often occurs in adolescence. By 2009, recognizing the lack of benefit as well as harms in screening young women, guidelines were revised to initiate cervical cancer screening for the general population at age 21. By comparing cervical cancer incidence in young WLHIV to that of the general population, we assessed the potential for increasing the recommended age of initiating cervical cancer screening in WLHIV.
We compared age-specific invasive cervical cancer (ICC) rates among WLHIV to the general population in the United States HIV/AIDS Cancer Match Study.
We estimated standardized incidence ratios as the observed number of cervical cancer cases among WLHIV divided by the expected number, standardized to the general population by age, race/ethnicity, registry and calendar year.
ICC rates among WLHIV were elevated across all age groups between ages 25–54 (SIR=3.80; 95%CI 3.48, 4.15), but there were zero cases among ages <25.
The absence of ICC among WLHIV <25 years supports initiating cervical cancer screening at age>21, rather than adolescence, to prevent cancers in WLHIV at ages with higher risk of ICC.