Abstract
Objective
To examine the influence of the AIDS epidemic on the incidence of Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) in Ontario.
Methods
Age-standardized incidence rates for KS and NHL from 1981 to 2000 were calculated from the population-based Ontario Cancer Registry. AIDS cases were extracted from Ontario Ministry of Health and Long-Term Care reports. HIV death data were obtained from the Ontario Cancer Registry.
Results
KS was a rare cancer before the 1980s; however, incidence increased sharply between 1985 and 1995 by 13.8% per year. Thereafter, incidence rates fell close to those in the early 1980s. NHL incidence in males increased steadily during the 1980s at 3.2% per year and then slowed beyond 1990. In males aged 30–44, NHL incidence rose from 1981 to 1990 (8.8% per year) and then fell (−2.5%) thereafter. NHL and KS cases represented one-third of HIV deaths.
Conclusions
The AIDS epidemic, the introduction of antiretroviral therapies, and the decrease in HIV infection rates explain the rise and decline of KS incidence in Ontario. NHL incidence trends are more complex, although the AIDS epidemic explains the trends observed in younger men (in whom AIDS is more common), and for the AIDS-related subtypes.
Similar content being viewed by others
References
Eltom MA, Jemal A, Mbulaiteye SM, Devesa SS (2002) Trends in Kaposi’s sarcoma and non-Hodgkin’s lymphoma incidence in the United States from 1973 through 1998. J Natl Cancer Inst 94:1204–1210
Biggar RJ (2001) AIDS-related cancers in the era of highly active antiretroviral therapy. Oncology (Williston Park) 15:439–449
Hymes KB, Cheung T, Greene JB et al (1981) Kaposi’s sarcoma in homosexual men-a report of eight cases. Lancet 2:598–600. doi:10.1016/S0140-6736(81)92740-9
Friedman-Kien AE (1981) Disseminated Kaposi’s sarcoma syndrome in young homosexual men. J Am Acad Dermatol 5:468–471
Ziegler JL, Drew WL, Miner RC et al (1982) Outbreak of Burkitt’s-like lymphoma in homosexual men. Lancet 2:631–633. doi:10.1016/S0140-6736(82)92740-4
Ziegler JL, Beckstead JA, Volberding PA et al (1984) Non-Hodgkin’s lymphoma in 90 homosexual men. Relation to generalized lymphadenopathy and the acquired immunodeficiency syndrome. N Engl J Med 311:565–570
Centre for Disease Control (1992) 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep 41(17):1–20
Gail MH, Pluda JM, Rabkin CS et al (1991) Projections of the incidence of non-Hodgkin’s lymphoma related to acquired immunodeficiency syndrome. J Natl Cancer Inst 83:695–701. doi:10.1093/jnci/83.10.695
Montaner JSG, Le T, Hogg R et al (1994) The changing spectrum of AIDS index diseases in Canada (short communication). AIDS 8:693–696. doi:10.1097/00002030-199405000-00018
Public Health Agency of Canada (2006) HIV and AIDS in Canada. Surveillance Report to June 30, 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, p 35
Public Health Agency of Canada (2006) Cancer Surveillance On-Line. Cancer incidence over time (Kaposi sarcoma, males, all ages, Ontario, 1992–2004). http://dsol-smed.phac-aspc.gc.ca/dsol-smed/cancer/c_time_e.html. Accessed 23 May 2008
Clarke CA, Glaser SL, Dorfman RF, Bracci PM, Eberle E, Holly EA (2004) Expert review of non-Hodgkin’s lymphoma in a population-based cancer registry: reliability of diagnosis and subtype classifications. Cancer Epidemiol Biomarkers Prev 13:138–143. doi:10.1158/1055-9965.EPI-03-0250
Clarke CA, Undurraga DM, Harasty PJ, Glaser SL, Morton LM, Holly EA (2006) Changes in cancer registry coding for lymphoma subtypes: reliability over time and relevance for surveillance and study. Cancer Epidemiol Biomarkers Prev 15:630–638. doi:10.1158/1055-9965.EPI-05-0549
Morton LM, Turner JJ, Cerhan JR et al (2007) Proposed classification of lymphoid neoplasms for epidemiologic research from the Pathology Working Group of the International Lymphoma Epidemiology Consortium (InterLymph). Blood 110:695–708. doi:10.1182/blood-2006-11-051672
Holowaty E (1998) The Ontario Cancer Registry. In: Black RJ, Simonato L, Storm HH, Demaret E (eds) Automated data collection in cancer registration. International Agency for Research on Cancer (IARC), Lyon, pp 2–34 (IARC Technical Report No. 32)
Percy C, Van Holten V, Muir C (eds) (1990) international classification of disease for oncology, 2nd edn. World Health Organization, Geneva, Switzerland, pp xxxiv, 45–47
Percy C, O’Conor G, Ries LG, Jaffe ES (1984) Non-Hodgkin’s lymphomas. Application of the International Classification of Diseases for Oncology (ICD-O) to the Working Formulation. Cancer 54:1435–1438. doi:10.1002/1097-0142(19841001)54:7<1435::AID-CNCR2820540734>3.0.CO;2-O
The Non-Hodgkin’s Lymphoma Pathologic Classification Project (1982) National Cancer Institute sponsored study of classifications of non-Hodgkin’s lymphomas: summary and description of a working formulation for clinical usage. Cancer 49:2112–2135. doi:10.1002/1097-0142(19820515)49:10<2112::AID-CNCR2820491024>3.0.CO;2-2
Carbone A (2003) Emerging pathways in the development of AIDS-related lymphomas. Lancet 4:22–29. doi:10.1016/S1470-2045(03)00957-4
Remis RS, Swantee C, Rottensten K, Schiedel L, Merid MF (2003) Report on HIV/AIDS in Ontario 2002. Ontario Ministry of Health, Toronto, Canada
Health Canada (1987) Revision of the CDC surveillance case definition for Acquired Immunodeficiency Syndrome. Can Dis Wkly Rep 13:169–176
Health Canada (1993) Revision of the surveillance case definition for AIDS in Canada. Can Commun Dis Rep 19:116–117
SAS Institute Inc. (1999–2001) SAS/Stat Software: changes and enhancements through Release 8.02. SAS Institute Inc., Cary, NC
National Cancer Institute (2003) Statistical research and applications branch. Joinpoint Regression Program, Version 2.7. USA
Adib SM, Joseph JG, Ostrow DG, Tal M, Schwartz SA (1991) Relapse in sexual behavior among homosexual men: a 2-year follow-up from the Chicago MACS/CCS. AIDS 5:757–760. doi:10.1097/00002030-199106000-00018
Sandin S, Hjalgrim H, Glimelius B, Rostgaard K, Pukkala E, Askling J (2006) Incidence of non-Hodgkin’s lymphoma in Sweden, Denmark, and Finland from 1960 through 2003: an epidemic that was. Cancer Epidemiol Biomarkers Prev 15:1295–1300. doi:10.1158/1055-9965.EPI-05-0958
Rabkin CS, Biggar RJ, Horm JW (1991) Increasing incidence of cancers associated with the human immunodeficiency virus epidemic. Int J Cancer 47:692–696. doi:10.1002/ijc.2910470511
Roche LM, Paul SM, Costa SJ (2001) Acquired immune deficiency syndrome and the increase in non-Hodgkin lymphoma incidence in New Jersey from 1979 to 1996: An age specific analysis. Cancer 92:2948–2956. doi:10.1002/1097-0142(20011201)92:11<2948::AID-CNCR10127>3.0.CO;2-T
Clarke CA, Glaser SL (2002) Changing incidence of non-Hodgkin lymphomas in the United States. Cancer 94:2015–2023. doi:10.1002/cncr.10403
Cote TR, Biggar RJ, Rosenberg PS et al (1997) Non-Hodgkin’s lymphoma among people with AIDS: incidence, presentation and public health burden. AIDS/Cancer Study Group. Int J Cancer 73:645–650. doi:10.1002/(SICI)1097-0215(19971127)73:5<645::AID-IJC6>3.0.CO;2-X
Beral V, Peterman T, Berkelman R, Jaffe H (1991) AIDS-associated non-Hodgkin lymphoma. Lancet 337:805–809. doi:10.1016/0140-6736(91)92513-2
Biggar RJ, Engels EA, Frisch M, Goedert JJ, AIDS Cancer Match Registry Study Group (2001) Risk of T-cell lymphomas in persons with AIDS. J Acquir Immune Defic Syndr 26:371–376
Goedert JJ, Cote TR, Virgo P et al (1998) Spectrum of AIDS-associated malignant disorders. Lancet 351:1833–1839. doi:10.1016/S0140-6736(97)09028-4
Holly EA, Lele C, Bracci P (1997) Non-Hodgkin’s lymphoma in homosexual men in the San Francisco Bay Area: occupational, chemical, and environmental exposures. J Acquir Immune Defic Syndr Hum Retrovirol 15:223–231
Holly EA, Gautam M, Bracci PM (2002) Comparison of interviewed and non-interviewed non-Hodgkin’s lymphoma (NHL) patients in the San Francisco Bay Area. Ann Epidemiol 12:419–425. doi:10.1016/S1047-2797(01)00287-3
Grulich AE, Li Y, McDonald AM, Correll PK, Law MG, Kaldor JM (2001) Decreasing rates of Kaposi’s sarcoma and non-Hodgkin’s lymphoma in the era of potent combination anti-retroviral therapy. AIDS 15:629–633. doi:10.1097/00002030-200103300-00013
Brodt HR, Kamps BS, Gute P, Knupp B, Stasweweski S, Helm EB (1997) Changing incidence of AIDS-defining illnesses in the era of antiretroviral combination therapy. AIDS 11:1731–1738. doi:10.1097/00002030-199714000-00010
Buchbinder SP, Holmberg SD, Scheer S, Colfax G, O’Malley P, Vittinghoff E (1999) Combination antiretroviral therapy and incidence of AIDS-related malignancies. J Acquir Immune Defic Synd 21(Suppl 1):S23–S26
Dore G, Li Y, Grulich A et al (1996) Declining incidence and later occurrence of KS among persons with AIDS in Australia: the Australian AIDS cohort. AIDS 10:1401–1406
International Collaboration on HIV and Cancer (2000) Highly active antiretroviral therapy and incidence of cancer in human immunodeficiency virus-infected adults. J Natl Cancer Inst 92:1823–1830. doi:10.1093/jnci/92.22.1823
Jones JL, Hanson DL, Dworkin MS, Jaffe HW, Adult/Adolescent Spectrum of Disease Project Group (2000) Incidence and trends in Kaposi’s sarcoma in the era of effective antiretroviral therapy. J Acquir Immune Defic Synd 24:270–274
Mocroft A, Kirk O, Clumeck N et al (2004) The changing pattern of Kaposi sarcoma in patients with HIV, 1994–2003: the EuroSIDA Study. Cancer 100:2644–2654. doi:10.1002/cncr.20309
Ledergerber B, Egger M, Ererd V, Swiss HIV Cohort Study et al (1999) AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA 282:2220–2226. doi:10.1001/jama.282.23.2220
Jones JL, Hanson DL, Dworkin MS, Ward JW, Jaffe HW (1999) Effect of antiretroviral therapy on recent trends in selected cancers among HIV-infected persons Adult/Adolescent Spectrum of HIV Disease Project Group. J Acquir Immune Defic Synd 21(Suppl 1):S11–S17
Kinlen L (1992) Immunosuppressive therapy and acquired immunological disorders. Cancer Res 52(19 suppl):5474s–5476s
Grulich AE (1999) AIDS-associated non-Hodgkin’s lymphoma in the era of highly active antiretroviral therapy. J Acquir Immune Defic Synd 21(Suppl 1):S27–30
Selik RM, Chu SY, Ward JW (1995) Trends in infectious diseases and cancers among persons dying of HIV infection in the United States from 1987 to 1992. Ann Intern Med 123:933–936
Selik RM, Byers RH Jr, Dworkin MS (2002) Trends in diseases reported on US death certificates that mentioned HIV infection, 1987–1999. J Acquir Immune Defic Synd 29:378–387
Selik RM, Anderson RN, McKenna MT, Rosenberg HM (2003) Increase in deaths caused by HIV infection due to changes in rules for selecting underlying cause of death. J Acquir Immune Defic Synd 32:62–69
Selik RM, Rabkin CS (1998) Cancer death rates associated with human immunodeficiency virus infection in the United States. J Natl Cancer Inst 90:1300–1302. doi:10.1093/jnci/90.17.1300
Canadian AIDS Society and Health Canada (2002) A guide to HIV/AIDS epidemiological and surveillance terms. Canadian AIDS Society; Centre for Infectious Diseases Prevention and Control (CIDPC), Public Health Agency of Canada, Health Canada, Ottawa, Canada
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bahl, S., Theis, B., Nishri, D. et al. Changing incidence of AIDS-related Kaposi sarcoma and non-Hodgkin lymphoma in Ontario, Canada. Cancer Causes Control 19, 1251–1258 (2008). https://doi.org/10.1007/s10552-008-9196-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-008-9196-8