Vulval cancer incidence, mortality and survival in England: age‐related trends

Abstract

Objective To explore the trends and age characteristics of vulval cancer incidence, mortality, survival and stage of disease.Design Retrospective population-based observational study based on cancer registry and Office for National Statistics data.Setting England.Population All women diagnosed with vulval cancer, defined by the site of the tumour (ICD-10 code C51).Methods Including all C51 cases, Poisson regression was used to test for trends in incidence and mortality rates, and generalised linear modelling was used to test for trends in relative survival. Excluding women with melanomas, basal cell carcinomas and Paget disease, stage was investigated as a percentage of staged data by age.Main outcome measures Age-standardised incidence and mortality rates, relative survival rates and stage of disease at diagnosis.Results From 1990, there was a statistically significant increase in overall incidence (P = 0.018) and decrease in mortality (P < 0.001). In addition, there were statistically significant increases in overall survival (1-year, P < 0.001; 5-year, P < 0.001). However, from 1990, incidence increased in women aged 20-39 years (P = 0.002), 40-49 and 50-59 years (both P < 0.001) and 60-69 years (P = 0.030) and decreased in women aged 80 years and above (P < 0.001). There were statistically significant decreases in mortality in women aged ≥60 years (P < 0.001), and statistically significant increases in 1-year survival in women aged ≥40 years (P ≤ 0.047) and in 5-year survival in women aged 40-49 and ≥60 years (P ≤ 0.011). Stage patterns by age highlight diagnosis at an earlier stage in younger women and more advanced stage diagnosis in older women.Conclusion Survival from vulval cancer has improved and mortality has decreased since 1990. The overall incidence of disease has increased as a result of more new diagnoses in the under 70-year age group.

Changing Trends in Vulvar Cancer Incidence and Mortality Rates in Australia Since 1982

“…A population-based study in England also reported a significant decrease in mortality for women aged 60+ years between 1990Y1994 and 2006Y2010. 16 Consistent with this, recent analyses of vulvar cancer data from the United States (for the period 1973Y2010) and Canada (1992Y2008) have demonstrated an increase in 2-and 5-year relative survival ratios for all age groups, and particularly for women 80 years and older. 18 However, other population-based studies from the Netherlands have reported stable mortality rates for vulvar cancer.…”

“…A recent study in England reported an increase in the incidence of invasive vulvar cancer in women aged up to 70 years since 1990; in this study, a decrease in incidence for women 80 years or older was identified over the same period. 16 Analysis of in situ and invasive vulvar carcinomas from the US Surveillance Epidemiology and End Results database, which considered cases diagnosed over the period 1973 to 2004, also identified an increase in vulvar cancer incidence. 17 An annual increase in invasive vulvar cancer of 1.0% (95% CI, 0.6%Y1.4%) across all age groups was identified (as was an increase in in situ cancers of 3.5% [95% CI, 2.9%Y4.1%]); the authors concluded that the effects were seen across all ages, although detailed analysis for specific age groups was not presented.…”

Raman spectroscopy and multivariate analysis for the non invasive diagnosis of clinically inconclusive vulval lichen sclerosus

“…[14][15][16] The rising incidence of vulval cancer is primarily due to an increase in vulval cancer in women aged 70 and below, suggestive of an increase in HPV related disease. 1 This increase in HPV related disease may also account for the recent increase in the incidence of VIN. 17,18 Malignant transformation of vulval epithelial cells by high-risk HPV subtypes is mediated through integration of the HPV DNA with in the host genome leading to HPV induced expression of the E6 and E7 oncoproteins.…”

Sentinel node biopsy in vulvar cancer: Implications for staging

“…In the last decades, the incidence of vulvar cancer has been increasing [1,2]. The most common histological type is squamous cell cancer, comprising about 80% of all vulvar malignancies.…”