Empfehlungen zur Krebsvorsorge
Manfred Hensel, Franz Mosthaf
Von den gesetzlichen Krankenkassen in Deutschland generell empfohlene und bezahlte Krebsfrüherkennungsuntersuchungen (Quelle: AOK 2009). Von den Autoren unter Berücksichtigung der Leitlinien der European AIDS Clinical Society 11/09 angepasst für HIV-positive Patienten
| Problem |
Patient/Alter |
Prozedur |
Evidenz für Nutzen |
Intervall |
Kommentar |
| Zervixkarzinom |
Frauen ≥ 20 J. |
gynäkologische Genitaluntersuchung, Abstrich und zytologische Untersuchung |
Zervixkarzinommortalität ↓ |
1 Jahr |
- |
| Mammakarzinom |
Frauen 50-69 J. |
Mammographie |
Brustkrebsmortalität ↓ |
2 Jahre |
- |
| Analkarzinom |
Frauen und Männer
(insbesondere bei rezeptivem Analverkehr)Indikator: Feigwarzen |
Inspektion von Anus und Genitale, digital rektale Untersuchung (DRU), bei auffälligem Befund: hochauflösende Anoskopie und Proktoskopie mit Biopsie und Histologie |
Unbekannt, von einigen Experten empfohlen; (Wertigkeit des Abstriches mit Zytologie noch nicht ausreichend validiert) |
1 Jahr |
bei HIV-negativen Menschen in Deutschland bisher nicht empfohlen |
| Hautkrebs |
Männer und Frauen ≥ 35 J. |
Hautkrebsscreening |
Kontrovers |
- |
- |
| Kolorektalkarzinom |
Männer und Frauen ≥ 45 J. |
Koloskopie (in zweiter Linie: Stuhluntersuchung auf occultes Blut) |
bei HIV-negativen kolorektale Krebsmortalität ↓ |
5-10 Jahre |
bei HIV-negativen in Deutschland erst ab 55 LJ. empfohlen |
| Prostatakarzinom |
Männer > 45 J. |
Digital rektale Untersuchung ± PSA-Test |
Kontrovers |
1 Jahr |
bei HIV-negativen in Deutschland nur DRU empfohlen |
Quellen:
- Herida M, Mary-Krause M, Kaphan R, et al. Incidence of non-AIDS-defining cancers before and during the highly active antiretroviral therapy era in a cohort of human immunodeficiency virus-infected patients. J Clin Oncol. 2003;21:3447-53.
- Lewden C, May T, Rosenthal E, et al.; ANRS EN19 Mortalité Study Group and Mortavic1. Changes in causes of death among adults infected by HIV between 2000 and 2005: The "Mortalité 2000 and 2005" surveys (ANRS EN19 and Mortavic). J Acquir Immune Defic Syndr. 2008;48:590-8.
- Bonnet F, Chêne G, Thiébaut R, et al.; Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA). Trends and determinants of severe morbidity in HIV-infected patients: the ANRS CO3 Aquitaine Cohort, 2000-2004. HIV Med. 2007;8:547-54.
- Lewden C, Salmon D, Morlat P, et al.; Mortality 2000 study group. 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.
- Bonnet F, Burty C, Lewden C, et al.; Agence Nationale de Recherches sur le Sida et les Hépatites Virales EN19 Mortalité Study Group; Mortavic Study Group. Changes in cancer mortality among HIV-infected patients: the Mortalité 2005 Survey. Clin Infect Dis. 2009;48:633-9.
- Dal Maso L, Polesel J, Serraino D, et al.; Cancer and AIDS Registries Linkage (CARL) Study. Pattern of cancer risk in persons with AIDS in Italy in the HAART era. Br J Cancer. 2009;100:840-7.
- Spano JP, Costagliola D, Katlama C, Mounier N, Oksenhendler E, Khayat D. AIDS-related malignancies: state of the art and therapeutic challenges. J Clin Oncol. 2008;26:4834-42.
- Bonnet F, Chêne G. Evolving epidemiology of malignancies in HIV. Curr Opin Oncol. 2008;20:534-40. Review.
- Hoffmann C, Wolf E, Wyen C, et al. AIDS-associated Burkitt or Burkitt-like lymphoma: short intensive polychemotherapy is feasible and effective. Leuk Lymphoma. 2006 Sep;47:1872-80.
- Hoffmann C, Chow KU, Wolf E, et al. Strong impact of highly active antiretroviral therapy on survival in patients with human immunodeficiency virus-associated Hodgkin's disease. Br J Haematol. 2004;125:455-62.
- Hentrich M, Maretta L, Chow KU, et al. Highly active antiretroviral therapy (HAART) improves survival in HIV-associated Hodgkin's disease: results of a multicenter study. Ann Oncol. 2006;17:914-9.
- Hartmann P, Rehwald U, Salzberger B, et al. BEACOPP therapeutic regimen for patients with Hodgkin's disease and HIV infection. Ann Oncol. 2003;14:1562-9.
- Mosthaf FA, Hanhoff NJ, Goetzenich A, Wolf E, Knechten H. [High incidence of non-AIDS-defined cancers among HIV-infected patients in Germany. A 3-year nationwide review]. Dtsch Med Wochenschr. 2006;131:1849-52.
- Chow KU, Mitrou PS, Geduldig K, Helm EB, Hoelzer D, Brodt HR. Changing incidence and survival in patients with aids-related non-Hodgkin's lymphomas in the era of highly active antiretroviral therapy (HAART). Leuk Lymphoma. 2001;41:105-16.
- Wyen C, Fätkenheuer G, Hoffmann C. Die deutsche Lymphomkohorte-aktueller Stand. AIDS 2008, Wiley-Blackwell (Berlin) 2008; Hrsg. Hoffmann, Jäger
- Engels EA, Biggar RJ, Hall HI, et al. Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer. 2008 Jul 1;123(1):187-94
- Rauch A, Gaudieri S, Evison J, et al. Low current and nadir CD4+ T-cell counts are associated with higher hepatitis C virus RNA levels in the Swiss HIV cohort study. Antivir Ther. 2008;13(3):455-60.
- Crum-Cianflone N, Hullsiek KH, Marconi V, et al. Trends in the incidence of cancers among HIV-infected persons and the impact of antiretroviral therapy: a 20-year cohort study. AIDS. 2009 Jan 2;23(1):41-50.
- Silverberg MJ, Neuhaus J, Bower M, et al. Risk of cancers during interrupted antiretroviral therapy in the SMART study. AIDS. 2007 Sep 12;21(14):1957-63.
- Silverberg MJ, Chao C, Leyden WA, et al. HIV infection and the risk of cancers with and without a known infectious cause. AIDS. 2009 Nov 13;23(17):2337-45.
- Clifford GM, Rickenbach M, Lise M, et al. Hodgkin lymphoma in the Swiss HIV Cohort Study. Blood. 2009 Jun 4;113(23):5737-42.
- Carbone A, Cesarman E, Spina M, Gloghini A, Schulz TF. HIV-associated lymphomas and gamma-herpesviruses. Blood. 2009 Feb 5;113(6):1213-24.
- Diamond C, Taylor TH, Aboumrad T, Anton-Culver H. Changes in acquired immunodeficiency syndrome-related non-Hodgkin lymphoma in the era of highly active antiretroviral therapy: incidence, presentation, treatment, and survival. Cancer. 2006 Jan 1;106(1):128-35.
- Berretta M, Cappellani A, Di Benedetto F, et al. Clinical presentation and outcome of colorectal cancer in HIV-positive patients: a clinical case-control study. Onkologie. 2009 Jun;32(6):319-24.
- Mosthaf F. HIV-Infektion: Jährliche Tumorvorsorge. Dtsch Arztebl 2004; 101(16): A-1074
|
