ABSTRACT
BACKGROUND
As HIV positive patients live longer, they become susceptible to the development of non-AIDS defining malignancies. Little is known about routine cancer screening practices in that population and the factors associated with cancer screening.
OBJECTIVE
Evaluate 1) the proportion of patients with HIV who had any type of colorectal cancer (CRC) screening and 2) whether having a primary care physician (PCP) or seeking care in an integrated care practice is associated with higher CRC screening.
DESIGN
A cross-sectional chart abstraction study of patients with HIV enrolled in the Philadelphia Medical Monitoring Project (MMP).
PARTICIPANTS
MMP participants age 50 and older.
MAIN MEASURES
CRC screening defined as having a documented colonoscopy, sigmoidoscopy, barium enema, or fecal occult blood test after the age of 50.
KEY RESULTS
Out of 123 chart abstractions performed, 115 had a complete clinical record from MMP. The majority of the population was male (71.3%), Black/Hispanic (73.8%) and between the age of 50 and 59 (71.3%). 45.2% of patients did not have a PCP. The overall proportion of patients who received CRC screening was 46.9%. Having a documented PCP was the only factor strongly associated with CRC screening. Rates of screening were 66.7% among those with a PCP versus 28.5% among those without a PCP (χ2 p < 0.001). After adjusting for race, socioeconomic status, substance and alcohol abuse, the odds of getting CRC screening in those with a PCP was 4.59 (95% CI 2.01-10.48, p < 0.001). The type of practice where patients were enrolled into care was not associated with CRC screening.
CONCLUSIONS
Having a PCP significantly increases the likelihood of receiving CRC screening in patients with HIV. Competency in addressing primary care needs in HIV clinics will only become more important as patients with HIV age.
Similar content being viewed by others
REFERENCES
Frisch M, Biggar RJ, Engels E, et al. Association of cancer with AIDS-related immunosuppression in adults. JAMA. 2001;285(13):1736–45.
Engels E, Biggar R, Hall H, et al. Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer. 2008;123:187–94.
Patel P, Hanson D, Sullivan P, et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med. 2008;148:728–36.
US Cancer Statistics Working Group. United States cancer statistics. 1999–2007 Cancer Incidence and Mortality Data. Available at http://www.cdc.gov/cancer/colorectal. Accessed March 10, 2011.
Reinhold JP, Moon M, Tenner CT, Poles MA, Bini EJ. Colorectal cancer screening in HIV-infected patients 50 years of age and older: missed opportunities for prevention. Am J Gastroenterol. 2005;100:1805–12.
Iqbal S, Browne-McDonald V, Cerulli MA. Recent trends for colorectal cancer screening in HIV-infected patients. Dig Dis Sci. 2009;55(3):761–6.
Landon BE, Wilson IB, McInnes K, Landrum MB, Hirschhorn LR, Marsden PV, Cleary PD. Physician specialization and the quality of care for human immunodeficiency virus infection. Arch Intern Med. 2005;165:1133–9.
CDC. Medical Monitoring Project (MMP). http://www.cdc.gov/hiv/topics/treatment/mmp. Accessed March 10, 2011.
CDC. Vital signs: colorectal cancer screening among adults aged 50–75 years — United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59:808–12.
Lewden C, Salmon D, Morlat P, et al. Causes of death among human immunodeficiency virus (HIV)–infected adults in the era of potent antiretroviral therapy: Emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol. 2005;34:121–30.
Mocroft A, Brettle R, Kirk O, et al. Changes in the cause of death among HIV positive subjects across Europe: Results from the EuroSIDA study. AIDS. 2002;16:1663–71.
Carrascal AF, Montesano-Ostrander K, Rukeyser J, Agins BD. Training HIV clinicians and building a clinical workforce: the experience in New York State. AIDS Public Policy J. 2005;20(3–4):102–7.
Landon BE, Wilson IB, Wenger NS, et al. Specialty training and specialization among physicians who treat HIV/AIDS in the United States. J Gen Intern Med. 2002;17:12–22.
Sheth AN, Moore RD, Gebo KA. Provision of general and HIV-specific health maintenance in middle aged and older patients in an urban HIV clinic. AIDS Patient Care STDS. 2006;20:318–25.
Funder
Supported by funding by a cooperative agreement between the Philadelphia Department of Public Health and the Centers for Disease Control and Prevention (grant # U62 PS001608-01).
Prior Presentations
We presented an earlier version of the manuscript as a poster at the 2011 SGIM Mid-Atlantic Regional Meeting in Baltimore, Maryland and won the prize for best poster. This project was also considered for the Lipkin award at the 2011 SGIM National Convention in Phoenix, Arizona, where it was presented orally.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Momplaisir, F., Long, J.A., Badolato, G. et al. The Role of Primary Care Physicians in Improving Colorectal Cancer Screening in Patients with HIV. J GEN INTERN MED 27, 940–944 (2012). https://doi.org/10.1007/s11606-012-2010-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-012-2010-z