As antiretroviral therapy (ART) improves survival among HIV-infected individuals, they become susceptible to the diseases of middle and older ages, including epithelial malignancies. In sub-Saharan Africa, where HIV prevalence approaches 20%, breast cancer has become the most common malignancy and cause of cancer-related death among women. Few studies have addressed the effects of HIV infection and ART on the clinical presentation, treatment, and prognosis of breast cancer. We propose to investigate those effects amongst women in South Africa. We plan to compare HIV-infected and -uninfected breast cancer patients with respect to the presentation (including stage) of the cancer, tolerance and toxicity of treatment, and ultimately survival, taking ART and other prognostic factors into account. In our prior work, we studied demographic and clinical characteristics of 1200 breast cancer patients, of whom 18% were HIV+, diagnosed between 2007 and 2012 at the Chris Hani Baragwanath Academic Hospital Breast Clinic (CHBBC) located in Soweto, Johannesburg. This collaborative research program involving University of the Witwatersrand (Wits), Columbia University Medical Center (CUMC) and International Agency for Research on Cancer (IARC) partners has yielded 3 publications to date (the Wits contact PI and PD are former CUMC D43 trainees). We are now adding to our collaboration breast surgeons and oncologists at 5 other South African urban, peri-urban, and rural academic hospital centers where 3000 subjects will be recruited and followed for treatment and survival. Biomarkers relevant to HIV and aggressive tumor biology will be studied in a subset of patients using the PAM50 genomic assay on the NanoString Counter Platform. The Consortium constitutes a pan-South African network and base for further research on HIV and breast (and other) cancers. The CUMC collaborators will continue to provide guidance, especially for new investigators in the Consortium. Senior biostatisticians from Wits and CUMC will develop and guide the data analysis plan. Experienced CHBBC database developers in collaboration with our IARC consultant and m-Health Mobenzi platform developer in South Africa will integrate the standardized data collected from real-time m-Health technologies with existing databases at the 6 hospital sites to enable access-controlled data sharing. Two Wits PIs and the CUMC PI will lead the Consortium and meet on a regular schedule as will other senior investigators, as detailed in the proposal. Letters confirming enthusiastic participation and of support from Wits, the U KwaZulu- Natal, U Cape Town IARC and CANSA South Africa are attached.

Public Health Relevance

No prior large-scale multicenter, multiethnic prospective study has evaluated the impact of HIV and ART on breast cancer survival in sub-Saharan Africa. Given the rising incidence rates of breast cancer in regions with high HIV prevalence, such research is essential for optimum management of this most female cancer. These analyses will contribute to the development of evidence-based guidelines for management of breast cancer in HIV-positive women and will yield new insights into both HIV and breast cancer

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Dominguez, Geraldina
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Wits Health Consortium (Pty), Ltd
South Africa
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Ruff, Paul; Cubasch, Herbert; Joffe, Maureen et al. (2018) Neoadjuvant chemotherapy among patients treated for nonmetastatic breast cancer in a population with a high HIV prevalence in Johannesburg, South Africa. Cancer Manag Res 10:279-286
Shen, Megan Johnson; Prigerson, Holly G; Ratshikana-Moloko, Mpho et al. (2018) Illness Understanding and End-of-Life Care Communication and Preferences for Patients With Advanced Cancer in South Africa. J Glob Oncol :1-9
O'Neil, Daniel S; Prigerson, Holly G; Mmoledi, Keletso et al. (2018) Informal Caregiver Challenges for Advanced Cancer Patients During End-of-Life Care in Johannesburg, South Africa and Distinctions Based on Place of Death. J Pain Symptom Manage 56:98-106
Cubasch, Herbert; Dickens, Caroline; Joffe, Maureen et al. (2018) Breast cancer survival in Soweto, Johannesburg, South Africa: A receptor-defined cohort of women diagnosed from 2009 to 11. Cancer Epidemiol 52:120-127
McKenzie, Fiona; Zietsman, Annelle; Galukande, Moses et al. (2018) Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer - disparities in outcomes (ABC-DO) study. Int J Cancer 142:1568-1579
Joffe, Maureen; Ayeni, Oluwatosin; Norris, Shane Anthony et al. (2018) Barriers to early presentation of breast cancer among women in Soweto, South Africa. PLoS One 13:e0192071
Cubasch, Herbert; Joffe, Maureen; Ruff, Paul et al. (2017) Breast conservation surgery versus total mastectomy among women with localized breast cancer in Soweto, South Africa. PLoS One 12:e0182125
Singh, E; Joffe, M; Cubasch, H et al. (2017) Breast cancer trends differ by ethnicity: a report from the South African National Cancer Registry (1994-2009). Eur J Public Health 27:173-178
Cubasch, Herbert; Ruff, Paul; Joffe, Maureen et al. (2017) South African Breast Cancer and HIV Outcomes Study: Methods and Baseline Assessment. J Glob Oncol 3:114-124