New aspects of vulvar cancer: Changes in localization and age of onset
Introduction
In the United States vulvar cancer accounts for about 4% of cancers of the female reproductive organs with an estimated 3490 new cases diagnosed in 2007, and an estimated 880 women will die from vulvar cancer (www.cancer.org) The incidence is estimated to be 2.5 per 100,000 women per year, leading to about 1600 new cases per year in Germany (RKI, 2004); it is five times less frequent than cervical cancer (incidence 12 per 100,000 women per year).
Recent data show a striking increase in the incidence of vulvar intraepithelial neoplasia (VIN) as a precursor lesion of the undifferentiated form of invasive vulvar carcinoma over the last 30 years in New Zealand [1], United States [2], [3], Norway [4] and Austria [5], [6]. In contrast, the overall incidence of invasive vulvar cancer has not changed in Austria [5], [6], whereas in the US population, an increase of 20% between 1973 and 2000 was reported in the study of Judson et al. published in 2006 [2].
The Department of Obstetrics and Gynecology of the University Hospital of Duesseldorf, Germany has a large unit for the diagnosis and treatment of dysplasia of the lower genital tract. We have anecdotally observed a striking trend towards younger women presenting with vulvar tumors, preferentially located in the area of the anterior vulva between clitoris and urethra. The tumors in these young females are mostly due to HPV infections [7], [8], [9], [10]. We recently reported on an 18-year old woman with a T3, HPV 52-positive invasive squamous vulvar cancer between clitoris and urethra [11], followed by the cases of two 25- and 32-year old women with large single lymph node metastases due to early invasive vulvar cancer located between clitoris and urethra (Hampl et al., submitted).
To validate these personal observations, we decided to perform a systematic, retrospective review of the clinicopathologic records for all women treated at our unit for invasive vulvar cancer between 1980 and 2007. The aim of this statistical evaluation was to validate the incidence of these tumors in a German university hospital unit, the changes in age, tumor stage and localization and suspected relation to HPV infection. Such data are not available for Germany so far.
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Materials and methods
A total of 224 women presenting with invasive vulvar carcinoma between January 1980 and June 2007 were identified using the surgical documentation system of the Department of Obstetrics and Gynecology, University of Duesseldorf, Germany. We performed a retrospective analysis of patients' records for three nine-year periods: 1/1980 to 02/1989; 3/1989 to 04/1998 and 05/1998 to 06/2007. The three periods were of the same length (110 months) to have comparable data sets. For each cohort, we
Results
The results of this analysis are summarized in Table 1 and Fig. 1. Between 1/1980 and 2/1989 (cohort 1), 53 women were admitted and treated in our unit for primary invasive vulvar cancer. The mean age was 65.6 years (standard deviation 12.6, min 31 years, max 91 years). Six women (11%) were 50 years old or younger. In the second cohort between 03/1989 and 04/1998 (cohort 2), 69 women presented with this diagnosis, and had a mean age of 63.9 years (standard deviation 16.3, min 31 years, max
Discussion
The Department of Gynecology and Obstetrics at the University of Düsseldorf in Germany has been a referral center specialized in gynecologic oncology and treatment of lower genital tract intraepithelial neoplasia for decades. There seemed to be an increase in the number of young women presenting with invasive vulvar cancer, especially since the turn of the century without any obvious reason to think that the referral pattern had changed. Furthermore, other colleagues specialized in treating
Acknowledgments
We are grateful to Margret Haugh for revising and editing the manuscript. We thank Dipl. med. U. Schulz for the help in statistical evaluation of the data.
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