Cancer In South Africa Research Articles

Temporal trends in the epidemiology of cervical cancer in South Africa (1994-2012).

Cervical cancer (CC) is the leading cause of cancer death among female South Africans (SA). Improved access to reproductive health services following multi-ethnic democracy in 1994, HIV epidemic, and the initiation of CC population-based screening in early 2000s have influenced the epidemiology of CC in SA. We therefore evaluated the trends in CC age-standardised incidence (ASIR) (1994-2009) and mortality rates (ASMR) (2004-2012) using data from the South African National Cancer Registry and the Statistics South Africa, respectively. Five-year relative survival rates and average per cent change (AAPC) stratified by ethnicity and age-groups was determined. The average annual CC cases and mortalities were 4,694 (75,099 cases/16 years) and 2,789 (25,101 deaths/9 years), respectively. The ASIR was 22.1/100,000 in 1994 and 23.3/100,000 in 2009, with an average annual decline in incidence of 0.9% per annum (AAPC = -0.9%, p-value < 0.001). The ASMR decreased slightly by 0.6% per annum from 13.9/100,000 in 2004 to 13.1/100,000 in 2012 (AAPC = -0.6%, p-value < 0.001). In 2012, ASMR was 5.8-fold higher in Blacks than in Whites. The 5-year survival rates were higher in Whites and Indians/Asians (60-80%) than in Blacks and Coloureds (40-50%). The incidence rate increased (AAPC range: 1.1-3.1%, p-value < 0.001) among young women (25-34 years) from 2000 to 2009. Despite interventions, there were minimal changes in overall epidemiology of CC in SA but there were increased CC rates among young women and ethnic disparities in CC burden. A review of the CC national policy and directed CC prevention and treatment are required to positively impact the burden of CC in SA.

Synchronous oligometastases in cervical cancer: a case report

Incidence and mortality of cervical cancer in South Africa is still very high and 4-6% of women present with FIGO stage IVB disease. However, the management of oligometastatic cervical cancer is no...

LBP‐001: Epidemiology and risk factors associated with liver cancer in South Africa

LBP‐001: Epidemiology and risk factors associated with liver cancer in South Africa

Illness Understanding and End-of-Life Care Communication and Preferences for Patients With Advanced Cancer in South Africa

PurposeThe understanding of patients with cancer of their condition and their wishes regarding care as they approach end of life (EoL) have been studied more in high-income countries than in low- and middle-income countries (LMICs).Patients and MethodsData were analyzed from a cohort study (N = 221) of patients with advanced cancer who were recruited from a palliative care center in Soweto, South Africa (LMIC), between May 2016 and June 2017. Patients were asked about their understanding of their illness, estimated life expectancy, EoL care communication, and EoL care preferences.ResultsOnly 13 patients (5.9%) acknowledged that they were terminally ill; nine patients (4.1%) estimated accurately that they had months, not years, left to live. A total of 216 patients (97.7%) reported that they had not had an EoL care discussion with their physician, and 170 patients (76.9%) did not want to know their prognosis even if the doctor knew it. Most patients preferred comfort care (72.9%; n = 161) to life-extending care (14.0%; n = 31), and did not want to be kept alive using extreme measures (80.5%; n = 178) or have their doctors do everything possible to extend their lives (78.3%; n = 173). Finally, 127 patients (57.5%) preferred to die at home, and 51 (23.1%) preferred to die in the hospital. Most patients (81.0%; n = 179) had funeral plans.ConclusionSouth African patients demonstrated less awareness of the fact that they were terminally ill, were less likely to have discussed their prognosis with their doctor, and more strongly preferred comfort care to life-extending EoL care than US and other LMIC patients in prior research. These differences highlight the need for culturally appropriate, patient-centered EoL care for South African patients with advanced cancer as well as to determine individual preferences and needs in all EoL settings.

Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival.

Colorectal cancer (CRC) is the fourth most common cancer in South Africa (SA), and the sixth most lethal. Approximately 25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Although chemotherapy is used in most stages of the disease, surgical resection of the primary tumour and metastases remains the most successful treatment modality to achieve cure or prolong survival. To date, no data on CRC presentation and management have been published in SA. To determine CRC presentation, general management patterns and overall survival in the SA private healthcare sector. A retrospective review of a private healthcare funder's database from 1 January 2008 to 31 December 2015. International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnosis codes were used to identify colorectal cancer and liver and/or pulmonary metastatic disease. Procedure codes assigned to hospital admissions were used to identify type of surgical treatment. Chemotherapy was identified by the World Health Organization Anatomical Therapeutic Chemical Classification System of medicines. Treatment patterns were determined and 5-year survival rates for these were calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional hazards regression was used for between-group comparisons of survival. Data analysis was carried out using SAS version 9.4 for Windows. A total of 3 412 patients were included in the study, 2 267 with CRC only and 1 145 with liver (LM) or pulmonary metastases (PM). The mean age was 64.1 years (range 21 - 97), and 54.6% were male; these did not differ statistically between the study groups. Twenty percent of patients with LM or PM underwent surgical resection of their metastases. Five-year survival rates following surgical resection of all disease for CRC only, CRCLM, CRCPM and CRCLMPM were 71.7%, 57.3%, 31.5% and 26.0%, respectively. SA CRC patients treated in the private healthcare sector have similar disease presentation to that in published international series, with similar outcomes following various treatment pathways; however, it seems that fewer resections of metastases are undertaken compared with international trends.

Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival

Background. Colorectal cancer (CRC) is the fourth most common cancer in South Africa (SA), and the sixth most lethal. Approximately 25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Although chemotherapy is used in most stages of the disease, surgical resection of the primary tumour and metastases remains the most successful treatment modality to achieve cure or prolong survival. To date, no data on CRC presentation and management have been published in SA.Objectives. To determine CRC presentation, general management patterns and overall survival in the SA private healthcare sector.Methods. A retrospective review of a private healthcare funder’s database from 1 January 2008 to 31 December 2015. International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnosis codes were used to identify colorectal cancer and liver and/or pulmonary metastatic disease. Procedure codes assigned to hospital admissions were used to identify type of surgical treatment. Chemotherapy was identified by the World Health Organization Anatomical Therapeutic Chemical Classification System of medicines. Treatment patterns were determined and 5-year survival rates for these were calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional hazards regression was used for between-group comparisons of survival. Data analysis was carried out using SAS version 9.4 for Windows.Results. A total of 3 412 patients were included in the study, 2 267 with CRC only and 1 145 with liver (LM) or pulmonary metastases (PM). The mean age was 64.1 years (range 21 - 97), and 54.6% were male; these did not differ statistically between the study groups. Twenty percent of patients with LM or PM underwent surgical resection of their metastases. Five-year survival rates following surgical resection of all disease for CRC only, CRCLM, CRCPM and CRCLMPM were 71.7%, 57.3%, 31.5% and 26.0%, respectively.Conclusions. SA CRC patients treated in the private healthcare sector have similar disease presentation to that in published international series, with similar outcomes following various treatment pathways; however, it seems that fewer resections of metastases are undertaken compared with international trends.

Abstract A11: A deep learning approach for extracting clinically relevant information from pathology reports

Abstract Data-Driven Healthcare, IBM Research Africa, Johannesburg, South Africa The National Cancer Registry (NCR) in South Africa plays a significant role in reporting nationwide cancer statistics and raising the global awareness of the massive impact of cancer. The government requires confirmed cancer cases to be reported to the NCR. Due to manual processes and the increasing magnitude of reports received annually, a considerable lag time exists in cancer statistics, which means the extent of the cancer cases is currently not understood. In addition, the unstructured free-text also needs to be processed in order to identify clinical information that could be important for public health planning. We present initial results from a deep learning approach to address this time lag. Deep learning is a powerful machine-learning algorithm that has made strides in the area of medical image recognition and speech processing. The deep learning system takes as input 2000 de-identified breast cancer pathology reports provided by the NCR in collaboration with the University of Witwatersrand Medical School. The pathology reports are first preprocessed using the Tf-idf (term frequency-inverse document frequency) method, which suggests how important a word is to a document in a corpus by assigning a numerical statistic to each word and hence obtain a term frequency document matrix. The high dimensional data matrix is, input into an unsupervised learning autoencoder, a data compression algorithm used to attain rich features that best represents the specific breast cancer topography and morphology. Unlike other approaches, our approach relies on non-dictionary sources such as clinical empirical knowledge extracted from the reports and dictionary sources such as the 12,000 medical diagnoses available in the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The output from the deep learning system can be used to automate the classification of reports into their corresponding topography and morphology. The system could also be used to create a visual analytics system to aid data exploration and trend analysis of the current state of cancer in South Africa. Citation Format: Waheeda Banu Saib, Pavan Kumar, Geoffrey Siwo, Gciniwe Dlamini, Elvira Singh, Sue Candy, Michael Klipin. A deep learning approach for extracting clinically relevant information from pathology reports [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A11.

Evidence-based feedback about emotional cancer challenges experienced in South Africa: A qualitative analysis of 316 photovoice interviews

ABSTRACTThis study aims to offer evidence-based feedback about the emotional challenges of cancer in South Africa. The action research photovoice methodology was used to capture accounts of cancer-related challenges via 316 face-to-face interviews with cancer patients and family members (n = 286), and oncology support and medical staff (n = 30). The photovoice contributions constituted qualitative data that were analysed according to inductive thematic analysis whereby nine themes of cancer challenges were identified and photovoice images were descriptively summarised from a phenomenological perspective. The emotional challenges theme was the most commonly reported of these themes, and is the focus of this paper. The findings of this study highlighted widespread emotional distress, anxiety, loss, poverty, physical challenges, traumatic impact of a cancer diagnosis, cancer stigma and low patient empowerment in the medical setting. Four main causes of patient emotional isolation in advanced stages of cancer are also identified, and this extends current understanding and offers new direction for clinical management. Recommendations from these findings include the need for the development and inclusion of psychosocial oncology services, best-practice standards of care, distress screening, patient empowerment and the prioritising of training and support for oncology staff in the South African health-care setting.

Draft Genome Sequence of a Multidrug-Resistant Serratia marcescens Strain, Isolated from a Patient with Peritoneal Cancer in South Africa.

ABSTRACTWe report here the draft genome sequence of Serratia marcescens ML2637, isolated from a South African pediatric patient in the intensive care unit with peritoneal cancer. The genome comprised 5,718,350 bp, with a 59.1% G+C content. There were 5,594 predicted genes, including 5,301 protein-coding genes, 199 pseudogenes, and 94 RNA genes.

Oesophageal cancer in South Africa: The long timeline from onset of symptoms to definitive management

&lt;strong&gt;Background:&lt;/strong&gt; In rural South Africa, most patients with oesophageal cancer have delayed presentations with debilitating symptoms and inoperable disease. This study was undertaken to quantify the delay between onset of symptoms and definitive treatment in a cohort of patients in rural South Africa, presenting to a state hospital in KwaZulu-Natal. The study also sought to establish reasons for delays in seeking medical attention and identify ways to encourage earlier presentation.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a two-armed study of patients with oesophageal cancer seen at Greys Hospital in Pietermaritzburg. One was a retrospective chart review establishing a timeline. The second part was a prospective study between June and November 2012 where data were collected by means of patient interviews.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; One hundred and thirteen charts were reviewed. The time from first symptoms to definitive management ranged from 2 to 14 months (average 7 months). Forty-six patients were interviewed. All experienced dysphagia but 83% were only prompted to seek help after weight loss. The duration of symptoms prior to first clinic or hospital attendance was 0–12 months (average 3 months). The reasons for the delay included the following: 41% of patients did not consider dysphagia a significant symptom, 24% had no money, 19% sought the help of traditional healers first and 15% said the hospital was too far away.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; There are long delays in the management of oesophageal cancer in our setting. The delays are prehospital as well as within the health care system. Lack of knowledge about oesophageal cancer symptoms and limited access to health care contributed to delays in management. Targeted quality improvement interventions are necessary. Patient education and improved referral systems are vital in encouraging earlier presentation.

The Effect of Access to Information on Beliefs Surrounding Breast Cancer in South Africa.

Breast cancer is the most common cancer affecting women in South Africa. There is little knowledge of beliefs to help identify key areas to improve support and education in this demographically and culturally diverse population. Women with a variety of demographic and socioeconomic characteristics accessing care for breast cancer were asked their agreement to statements of knowledge and beliefs about breast cancer. Of the 259 participants, positive statements of medical cure (87.9%) and family support (90.5%) were most commonly believed. Beliefs in faith-based cure and alternative treatments were also present (79.5 and 24.9%, respectively). Negative beliefs were initially more likely in black patients (RR: 11.57, 95%CI: 1.37-97.69) as was belief of cancer as a punishment (RR: 6.85, 95%CI: 1.41-33.21). However, in multivariate analysis adjusting for age, education and access to information (by newspaper, Internet and confidence in reading and writing), there was no difference between racial groups or hospital attended. Reading a newspaper or accessing the Internet was the most protective against belief that cancer was a punishment or curse (Internet use: aRR: 0.12, 95%CI: 0.02-0.99), belief in alternative methods of cure (newspaper use: aRR: 0.51, 95%CI: 0.27-0.96) and the negative beliefs of death and disfigurement (Internet use: aRR: 0.00, 95%CI: 0.00-0.00). Positive expressions of cure and beating cancer were found equally in all women. Attitudes and beliefs about cancer showed little independent demographic or socioeconomic variance. Negative beliefs were mitigated by access to information and confidence in literacy.

Challenges and Progress of Policies on Cervical Cancer in South Africa

Cervical cancer is the second most common cancer in South African women but the most frequently encountered cancer in black women. In 2000, the South African Department of Health launched a national cervical screening program. However, this has not been fully implemented because of the chronic shortage of health care workers and a lack of essential medical equipment. In addition, there is also a high burden of infectious diseases in this country. South Africa has the largest expanding HIV burden in the world and it is estimated that 6.3 million people in South Africa were living with HIV in 2013, representing 18% of all people living with HIV worldwide. The high prevalence of HIV complicates the situation as HIV-infected women have greater rates of pre-invasive and invasive cervical cancer rates. In April 2011 the South African government launched the HIV Counseling and Testing (HCT) campaign, a new national drive to encourage people to know their HIV status and access counseling and treatment, including cervical screening. A universal test and treat (UTT) strategy was adopted in September 2016 after research showed that this type of program will reduce the chance of HIV transmission. The South African National Department of Health will soon announce and implement a new cervical cancer control policy. Over the past few years, the South African Department of Health has introduced several new policies regarding HIV testing and care, and plans to introduce a new cervical screening policy shortly. This overview discusses the progress as well as challenges the South African department of health has with the various programs.

The future cost of cancer in South Africa: An interdisciplinary cost management strategy

The future cost of cancer in South Africa: An interdisciplinary cost management strategy

The future cost of cancer in South Africa: An interdisciplinary cost management strategy.

The future cost of cancer in South Africa: An interdisciplinary cost management strategy.

Is Clinical Research in Oesophageal Cancer in South Africa in Crisis? A Systematic Review.

Oesophageal cancer (OC) is responsible for the second highest number of cancer-related deaths in South Africa (SA). Squamous cell carcinoma is the most prevalent type with an incidence of 46.7/100,000 and 19.2/100,000 for males and females. This is a systematic review of the clinical diagnosis and management of OC within the South African context. This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016034053) with adherence to PRISMA guidelines. An online search was performed using MEDLINE, EBSCOHost and PubMed. Eligibility criteria for articles included published, original peer-reviewed research addressing clinical management of oesophageal cancer in South Africa. Review articles, case reports, scientific letters and studies published in languages other than English or Afrikaans were excluded. The research terms were 'etiology', 'human', 'esophageal cancer', 'esophageal carcinoma', 'oesophageal cancer', and 'oesophageal carcinoma', 'squamous cell carcinoma', 'Africa' and 'South Africa'. A total of 336 articles were identified. Of these, 146 were immediately excluded and a further 159 were excluded after review. A total of 31 appropriate articles, i.e. 9.2% of searched articles, were included. Thirteen articles addressed chemotherapy and/or radiotherapy, 9 oesophageal luminal therapy, 7 oesophageal surgery and 2 screening. OC research of in SA over the last two decades has mainly been in the form of reviews and opinion papers. Clinical research, auditing and prospectively analysing OC management and outcomes in SA hospitals are sorely needed and should be promoted by both healthcare workers and policy makers alike.

Investigation of breast cancer sub-populations in black and white women in South Africa.

Bimodal age distributions at diagnosis have been widely observed among US and European female breast cancer populations. To determine whether bimodal breast cancer distributions are also present in a sub-Saharan African population, we investigated female breast cancer in South Africa. Using the South African National Cancer Registry data, we examined age-at-diagnosis frequency distributions (density plots) for breast cancer overall and by their receptor (oestrogen, progesterone and HER2) determinants among black and white women diagnosed during 2009-2011 in the public healthcare sector. For comparison, we also analysed corresponding 2010-2011 US SEER data. We investigated density plots using flexible mixture models, allowing early/late-onset membership to depend on receptor status. We included 8857 women from South Africa, 7176 (81%) with known oestrogen receptor status, and 95064 US women. Bimodality was present in all races, with an early-onset mode between ages 40-50years and a late-onset mode among ages 60-70years. The early-onset mode was younger in South African black women (age 38), compared to other groups (45-54years). Consistent patterns of bimodality and of its receptor determinants were present across breast cancer patient populations in South Africa and the US. Although the clinical spectrum of breast cancer is well acknowledged as heterogeneous, universal early- and late-onset age distributions at diagnosis suggest that breast cancer etiology consists of a mixture two main types.

905TiP - Interim statistical analysis on a phase III randomised trial investigating the addition of modulated electro-hyperthermia to chemoradiation for cervical cancer in HIV positive and negative women in South Africa

Cervical cancer is the second most common cancer in South Africa where funding and resources for treatment are limited and HIV infection rates are high. A Cochrane review (2010) on pooled data from six randomised trials showed a potential benefit to the addition of hyperthermia (HT) to radiotherapy (RT) protocols for cervical cancer. The Dutch Deep Hyperthermia trial (2010) reported a cost saving per quality adjusted life year when HT was added to RT protocols. The potential cost-saving resulting from the addition of HT to cervical cancer treatment protocols may lower the burden on healthcare facilities in South Africa and improve treatment options in HIV positive patients. Trial design: The aim is to determine the clinical effects of the addition of modulated electro-hyperthermia (mEHT) on the standard treatment protocols for locally advanced cervical cancer patients in state healthcare in South Africa. The objectives are to assess the effects of the addition of mEHT on local disease control, quality of life, acute and late toxicity and survival. Method: This is an ongoing phase III randomised clinical trial conducted at the Charlotte Maxeke Johannesburg Academic Hospital. The study aims to enrol 236 female participants with FIGO stage IIB (initial distal parametrium involvement) to IIIB cervical cancer (no bilateral hydronephrosis). Participants are being randomised into a “Hyperthermia” group (mEHT plus chemoradiation) and a “Control” group (chemoradiation alone), based on HIV status, age and stage of disease. All participants are receiving 25 fractions of 2Gy external beam radiation, 3 doses of high dose rate brachytherapy (8Gy) and up to 3 doses of cisplatin (80mg/m2). The Hyperthermia group is receiving two 55 minute local mEHT treatments per week during radiation therapy. Local disease control is being assessed by Positron Emission Tomography (PET) scans. Adverse events, quality of life and overall survival are being recorded and the data is being analysed. Ethics was obtained by the Human Research and Ethics Council (clearance number: M120477) Clinical trial identification: South African Department of Health Trial Registration number: DOH-27-0113-4012; Issued 26 June 2012 Legal entity responsible for the study: University of the Witwatersrand

The impact of HIV infection on the presentation of lung cancer in South Africa.

Despite the very high background prevalence of HIV and smoking-related diseases in sub-Saharan Africa, very little is knownabout the presentation of lung cancer in HIV-infected individuals. We prospectively compared HIV-positive (n=44) and HIV-negative lung cancer patients (n=425) with regard to demographics,cell type, performance status and umour node metastasis staging at initial presentation. HIV-positive patients were found to be younger than HIV-negative (mean 54.1 (standard deviation (SD) 8.4) years v. 60.5 (10)years, p&lt;0.01), more likely to have squamous cell carcinoma (43.2% v. 30.1%, p=0.07) and significantly more likely to have a poor EasternCooperative Oncology Group (ECOG) performance status of ≥3 (47.7% v. 29.4%, p=0.02). In the case of non-small cell-lung cancer, theywere also significantly less likely to have early stage lung cancer (0% v. 10.3%, p=0.02) compared with HIV-negative patients. HIV-positive lung cancer patients were younger, significantly more likely to have a poor performance status at presentationand significantly less likely to have early stage lung cancer when compared with HIV-negative patients.

Modelling the healthcare costs of skin cancer in South Africa.

BackgroundSkin cancer is a growing public health problem in South Africa due to its high ambient ultraviolet radiation environment. The purpose of this study was to estimate the annual health system costs of cutaneous melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in South Africa, incorporating both the public and private sectors.MethodsA cost-of-illness study was used to measure the economic burden of skin cancer and a ‘bottom-up’ micro-costing approach. Clinicians provided data on the patterns of care and treatments while national costing reports and clinician fees provided cost estimates. The mean costs per melanoma and per SCC/BCC were extrapolated to estimate national costs using published incidence data and official population statistics. One-way and probabilistic sensitivity analyses were undertaken to address the uncertainty of the parameters used in the model.ResultsThe estimated total annual cost of treating skin cancers in South Africa were ZAR 92.4 million (2015) (or US$15.7 million). Sensitivity analyses showed that the total costs could vary between ZAR 89.7 to 94.6 million (US$15.2 to $16.1 million) when melanoma-related variables were changed and between ZAR 78.4 to 113.5 million ($13.3 to $19.3 million) when non-melanoma-related variables were changed. The primary drivers of overall costs were the cost of excisions, follow-up care, radical lymph node dissection, cryotherapy and radiation therapy.ConclusionThe cost of managing skin cancer in South Africa is sizable. Since skin cancer is largely preventable through improvements to sun-protection awareness and skin cancer prevention programs, this study highlights these healthcare resources could be used for other pressing public health problems in South Africa.

Phenotype and Treatment of Breast Cancer in HIV-Positive and -Negative Women in Cape Town, South Africa

PurposeAn estimated 5.9 million people in South Africa are infected with HIV. Because antiretroviral therapy has made infection with HIV a treatable, chronic condition, HIV-infected individuals are now surviving to middle and older age. We investigated the implications of HIV status for breast cancer in South Africa.MethodsWe compared clinical and demographic characteristics of women newly diagnosed with a first primary breast cancer at Tygerberg Hospital, Cape Town, South Africa, from January 2010 to December 2011 by HIV status. We then compared HIV-positive patients with HIV-negative controls, matched 2:1 on age and ethnicity, with respect to chemotherapy regimens, toxicities, completion of systemic chemotherapy, and changes in CD4 cell count.ResultsOf 586 women with breast cancer, 31 (5.3%) were HIV positive, 420 (71.7%) were HIV negative, and 135 (23%) were untested for HIV. Women with HIV were younger than other women (P < .001). The groups did not differ in regard to stage at presentation, histologic subtype, tumor grade, nodal involvement, or hormone receptor positivity. More than 84% of patients who initiated systemic chemotherapy, regardless of HIV status, completed it without serious toxicity. Among HIV-positive patients receiving chemotherapy, the mean baseline CD4 cell count was 477 cells/µL (standard deviation, 160 cells/µL), and the mean nadir was 333 cells/µL (standard deviation, 166 cells/µL).ConclusionHIV-infected women were younger at breast cancer diagnosis than HIV-negative women but otherwise similar in phenotype and completion of chemotherapy. Longer term follow-up is needed to evaluate the effects of HIV, antiretroviral therapy, and chemotherapy on the survival and quality of life of patients with breast cancer.