Incidence Patterns and Temporal Trends of Invasive Nonmelanotic Vulvar Tumors in Germany 1999-2011. A Population-Based Cancer Registry Analysis

Abstract

ObjectivesTime trends on the incidence and characteristics of invasive vulvar cancer in Germany have so far been studied in few local population- and hospital based tumor registries. We aimed to provide an overview on recent developments of vulvar cancer in Germany, using population-based cancer registry data.MethodsWe analyzed the data on vulvar cancer of eight population-based German cancer registries for the period 1999-2011. ICD-10 codes and ICD-O-3 morphology codes were used to select site and histologic types. The annual percentage change was calculated on age-adjusted incidence rates with a joinpoint regression model.ResultsA total of 12,711 registered cases of invasive carcinoma of the vulva were included in the analyses, hereof were 12,205 of squamous cell origin. Age-standardized incidence rates of vulvar cancer annually increased by 6.7% (95% confidence limits: 5.6-7.9) from 1.7 per 100,000 women in 1999 to 3.6 per 100,000 women in 2011. An increase was observed among women of all ages, and especially between 30 and 69 years of age.ConclusionThe annual incidence of invasive carcinoma of the vulva nearly doubled in the past decade in Germany, considerably exceeding the rates observed in other Western European countries. A combination of changes in risk factors, and documentation practice might have contributed to the observed substantial increase in vulvar cancer incidence.

Vulvar cancer in Germany: increase in incidence and change in tumour biological characteristics from 1974 to 2013

“…This study based on CR data aimed to further investigate a recently reported increase in the incidence of invasive vulvar cancer in Germany [12] by providing stratified incidence trends with regard to age at diagnosis, tumour size and clinical stage, tumour morphology and histopathologic grade over a period of 25 years or longer. Since the beginning of the millennium, the ASR of the incidence of invasive vulvar cancer tripled from 2.5 to 7.9 cases per 100,000 women per year, which almost entirely resulted from additional squamous cell carcinomas and small T1 tumours.…”

“…A recent study reported an increase in vulvar cancer incidence in Germany from approximately two to four new cases per 100,000 women per year between 1999 and 2011 [12]. As some regions with a completeness of case ascertainment of less than 90% had been included in that study [25], it is very likely that the above-cited incidence figures underestimate the true cancer burden.…”

“…Compared to Germany, the incidence of invasive vulvar cancer was lower both in neighbouring countries and in other European or developed countries across the world [11]. In Austria, the Czech Republic, Belgium and the Netherlands, the ASR of incidence ranged between two and three in 2010/2011 [12]. The increase in vulvar cancer incidence observed in some other European countries or in North America was of lower dimensions.…”

“…Prior to the new millennium, the incidence of vulvar cancer in Germany had been quite similar to those in other European regions or industrialised countries [9,10]. In recent years, however, a significant increase in the incidence of vulvar cancer has been observed in some German regions [11], resulting in a much higher incidence in Germany compared to many neighbouring countries [12,13]. Along with the increase in incidence in Germany, a moderate increase in vulvar cancer mortality has been observed [13].…”

Vulva cancer in Ghana – Review of a hospital based data

“…In Western Europe, the average ages are over 70 years (Buttmann-Schweiger et al, 2015). The difference in average ages between Europe and the less developed countries could be explained by the difference in life expectancy at birth.…”