The skin cancer Kaposi Sarcoma (KS) is an HIV-related condition that primarily affects men, but a new cases series presented at IDWeek 2018 in San Francisco highlights the importance of studying women with KS.
Although KS is rare in women, some evidence suggests that it could be more aggressive when it does occur, said Anisha Apte, B.S., from Emory University School of Medicine in Atlanta, who presented the poster.
Apte and her colleagues sought to characterize cases of KS in women treated at Grady Memorial Hospital in Georgia. As one of the country's HIV epicenters, Georgia reported more cases of KS from 2009 to 2015 than any other state.
By pulling medical records from the Pathology Cancer Registry, they identified 96 cases of KS in men and six cases in women from 2010 to 2018. That's an incidence rate of 0.06 for women.
Of those six women, three were African American, one was white, and two were of African origin. All were heterosexual; two reported current or previous homelessness; and three reported alcohol, tobacco, or crack cocaine use.
All of the women had aggressive KS disease that required chemotherapy. Three were treated with chemo, and four started on antiretroviral treatment. One of the women checked into the hospital with stomach pain and diarrhea. She was coughing blood and, despite treatment, died of respiratory failure attributed to KS in her lungs. She was only 42 years old.
These six cases draw attention to the dearth of research on KS in women. In fact, incidence of KS in women is thought to be so miniscule that some researchers have excluded women from their analyses of KS incidence in the U.S.
Apte doesn't dispute that KS occurs far more frequently in men, but she said that her study highlights a noticeable lack of scientific literature about the relationship between biological sex and KS incidence, progression, and ideal treatment strategy.
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Another important takeaway is the importance of sending suspected KS samples out for verified biopsy, because there could be cases of KS in women that have never been recorded in the Pathology Cancer Registry, Apte said.
Regarding the aggressive nature of KS seen in the six women in Georgia, Apte said that two things could be going on.
First, it's possible "that KS happens more frequently in women, and clinicians are just not suspecting it, she said. "The other option is that, potentially, there's something immunosuppressive in a woman that may somehow differ and create an inflammatory reaction that may predispose women to more aggressive KS."
"There's very little data to support this; it's just a theory that's being bounced around," she added. But with all the attention focused on the incidence of KS in men, Apte argues the etiology of KS in women should be further explored.