Screening benefits for breast and colorectal cancer-specific survival among medicare enrollees with HIV

Objective: Cancer screening improves survival in the general population, but its effectiveness in people with HIV (PWH) remains underexplored, particularly for breast and colorectal cancer. This study examines the impact of cancer screening on cancer-specific survival among U.S. Medicare enrollees with HIV.

Methods: Using Medicare data (2009-2019) with follow-up through 2021, we identified PWH aged 50+ without baseline breast or colorectal cancer and with at least two years of fee-for-service coverage. Cox regression models were used to assess the association between cancer screening and cancer-specific survival, adjusting for sociodemographic factors and baseline comorbidities by age (50-64, 65+ years). Results: In total, 40,768 and 133,665 PWH were included for breast and colorectal cancer screening, with median follow-up of 7.4 and 7.6 years, respectively. Among females with HIV, breast cancer mortality was 0.28% (50-64 years) and 0.40% (65+ years), with significant screening benefits observed in both age groups. The hazard ratio (HR) was 0.53 (95% Confidence Interval [CI]: 0.32-0.87) and 0.47 (95% CI: 0.29-0.76) for those aged 50-64 and 65+, respectively. Colorectal cancer mortality was 0.31% (50-64 years) and 0.48% (65+ years), with screening colonoscopy providing significant survival benefit only in younger PWH (50-64: 0.41, 0.20-0.88; 65+: 0.42, 0.16-1.14). Conclusion: Breast cancer screening improved survival in all females with HIV aged 50+, while colonoscopy screening provided significant benefit only in PWH aged 50-64. This finding underscores the importance of cancer screening in PWH. Studies should assess the effect across modalities of colorectal cancer screening.