Mammogram Rates Among Women with and without HIV in a Large Integrated Healthcare System

Background: Prior studies have found that women with HIV (WWH) have similar or lower breast cancer risk compared with women without HIV (WWoH). Detection of breast cancer relies on regular screening, but previous studies comparing mammogram rates between WWH and WWoH have had mixed results. Setting: This study was conducted within Kaiser Permanente Northern California (KPNC), a large, integrated healthcare system. Methods: We conducted a cross-sectional study of WWH and 20:1 demographically-matched WWoH aged 50-74 years in December 2019. Mammogram data were abstracted from the electronic health record (EHR) for the prior 27 months, consistent with a 2-year recommendation for breast cancer screening with a 3-month grace period. We compared mammogram prevalence by HIV status using Poisson regression models, with adjustment for demographic and clinical factors. We then evaluated factors associated with receipt of mammograms in WWH and WWoH. Results: 345 WWH and 6,573 WWoH meeting study eligibility were included (demographically matched, mean age: 60.3 vs 60.4 years; White race: 38% for both groups). Mammogram prevalence was high in both groups (86% for WWH, 87% for WWoH), with an adjusted prevalence ratio (PR) of 0.95 (CI: 0.91-0.99). Among WWH, factors associated with reduced mammogram use included smoking, fewer outpatient encounters, and no HIV RNA measurement within prior year. Conclusion: Mammogram prevalence was high in WWH and WWoH at KPNC, exceeding national averages. Lower patient engagement with the healthcare system and smoking emerged as the most significant factors associated with reduced mammograms among WWH.