Young women with vulvar cancer have modifiable risk factors for the disease

NEW YORK (Reuters Health) - Young women with vulvar cancer tend to have early-stage disease, smoke cigarettes, have a history of the human papilloma virus and have vulvar dysplasia, according to results of a study published in the June issue of the American Journal of Obstetrics and Gynecology. Most of these risk factors are modifiable.

"Vulvar cancer is a relatively uncommon malignancy, occurring at a rate of 2.2 per 100,000 women per year," Dr. Patricia L. Judson, of the University of Minnesota, Minneapolis, and colleagues note. However, "a recent Surveillance, Epidemiology, and End Result Program-derived data review demonstrated that over the past 28 years, the prevalence of in situ and invasive vulvar carcinoma has increased," they add.

To determine whether those patients had different characteristics than others with vulvar cancer, the researchers examined the demographic, surgicopathologic, and outcome data for 56 women with squamous cell vulvar cancer who developed the disease at age 45 years or younger.

Almost half of patients reported the presence of symptoms for less than 6 months prior to diagnosis. The women had more tobacco exposure, and nearly 70% had a history of vulvar intraepithelial neoplasia (VIN) or cervical intraepithelial neoplasia (CIN). Patients who had advanced disease were less likely to have had dysplasia, human papilloma virus (HPV), or VIN. Overall, 6.7% of patients were immunocompromised.

Eighty percent of patients underwent modified radical vulvectomy with unilateral or bilateral lymph node dissection. Of these, positive nodes were found in 18% of patients. Compared to women with negative lymph nodes, those with positive lymph nodes were more likely to have had cervical dysplasia or HPV (p = 0.04).

"If we could get women to modify these behaviors, the incidence of vulvar cancer would be decreased," Dr. Judson told Reuters Health. "Women, and especially young women, are unaware of vulvar cancer. They are also unaware that cigarette smoking and exposure to the human papilloma virus increases their risk of developing vulvar cancer. The HPV vaccinations will help to decrease the incidence of this cancer."

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