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H. Amir, E. Kaaya, G. Kwesigabo, J. Kiitinya (2000)
Breast cancer before and during the AIDS epidemic in women and men: a study of Tanzanian Cancer Registry Data 1968 to 1996.Journal of the National Medical Association, 92 6
M. Frisch, R. Biggar, E. Engels, J. Goedert (2001)
Association of cancer with AIDS-related immunosuppression in adults.JAMA, 285 13
K. Kupka (1978)
International classification of diseases: ninth revision.WHO chronicle, 32 6
A. Toniolo, C. Serra, P. Conaldi, F. Basolo, V. Falcone, A. Dolei (1995)
Productive HIV‐1 infection of normal human mammary epithelial cellsAIDS, 9
T. Stewart, S. Tsai, H. Grayson, R. Henderson, G. Opelz (1995)
Incidence of de-novo breast cancer in women chronically immunosuppressed after organ transplantationThe Lancet, 346
Lewis CE
Tumor-associated leucocytes: friends or foes in breast carcinoma.
To the Editor: Drs Frisch and colleagues1 reported that breast cancer was the only malignancy, at least in women, to exhibit a statistically significant pattern of decreasing relative risk (RR) with increasing amounts of time following a diagnosis of acquired immunodeficiency syndrome (AIDS). A recent study also found a statistically significant decrease in the incidence of breast cancer, in both men and women, following the AIDS epidemic in Tanzania.2 Furthermore, some studies3 have found that immunosuppressed transplant recipients have a diminished incidence of breast cancer relative to other malignancies. This is contrary to what one would expect, since human immunodeficiency virus (HIV) infection theoretically increases the susceptibility to malignancy because of an acquired deficiency in immunosurveillance of tumor cells and/or an increased susceptibility to oncogenic viruses. In an attempt to accumulate cases to determine the clinicopathological correlation of breast cancer in HIV-positive persons at our hospital, we searched the International Classification of Diseases, Ninth Revision (ICD-9)4 billing codes of approximately 1.8 million patients for HIV disease. Of these patients, 2460 had at least 1 diagnostic code for HIV. We then searched these patient records for breast cancer codes and were surprised to find that only 2 patients had both HIV and breast cancer, particularly since our medical center serves as a referral center for patients with breast disease and HIV-related illness. It is unclear why so few HIV-positive patients are diagnosed with breast cancer. Is this phenomenon related to the fact that patients infected with HIV die before they manifest breast cancer, or are such infected individuals truly protected from developing breast cancer because of some direct or indirect effect on their breast epithelium and/or immune system? Replication of HIV within human mammary epithelial cells has been shown in vitro to reduce the growth of epithelial cells and to down-regulate their growth-factor receptors.5 Exactly what role the host's immune response plays in facilitating breast cancer development, however, remains controversial.6 Unquestionably, the answers will not only advance understanding of the biology of breast cancer but also may provide us further insight into alternative treatment modalities, such as immunotherapy. References 1. Frisch MBiggar RJEngels EAGoedert JJfor the AIDS-Cancer Match Registry Study Group, Association of cancer with AIDS-related immunosuppression in adults. JAMA. 2001;285:1736-1745.Google Scholar 2. Amir HKaaya EEKwesigabo GKiitinya JN Breast cancer before and during the AIDS epidemic in women and men: a study of Tanzanian cancer registry data 1968 to 1996. J Natl Med Assoc. 2000;92:301-305.Google Scholar 3. Stewart TTsai SCJGrayson HHenderson ROpelz G Incidence of de-novo breast cancer in women chronically immunosuppressed after organ transplantation. Lancet. 1995;346:796-798.Google Scholar 4. World Health Organization, International Classification of Diseases, Ninth Revision (ICD-9). Geneva, Switzerland: World Health Organization; 1977. 5. Toniolo ASerra CConaldi PGBasolo FFalcome VDolei A Productive HIV-1 infection of normal human mammary epithelial cells. AIDS. 1995;9:859-866.Google Scholar 6. O'Sullivan CLewis CE Tumor-associated leucocytes: friends or foes in breast carcinoma. J Pathol. 1994;172:229-235.Google Scholar
JAMA – American Medical Association
Published: Jun 27, 2001
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