Changes in incidence and primary site of vulvar cancer

Aims: To characterize the changes in incidence, age, tumor site of invasive vulvar cancer within a 28-year period. Methods: The clinical records of women treated for invasive vulvar cancer from 01/1980 until 06/2007 at the university of Dusseldorf were analyzed. We performed a retrospective analysis for three 9-year periods. For each cohort, the number of cases, age, tumor site and further characteristics were statistically evaluated. Results: A total of 224 patients were identified. The number and mean age changed significantly over time: between 1/1980 and 02/1989 53 women with a mean age of 65.6 y were treated, between 03/1989 and 04/1998 this number increased to 69 with a mean age of 63.9 y and in the last period, 102 women with a mean age of 57.0 y were treated. The increase was 192%. In the first period 11% were aged 50 years or less compared with over 41% in the third period (p=0.001). Two-third of the tumors women aged <50 years were HPV positive. Significant changes in the tumor site to the area of clitoris/urethra were observed. Conclusions: In contrast to the literature, the results of this study show a doubeling of patients presenting with invasive vulvar cancer within 3 decades, with a nearly 4x increase in younger patients (+ 372%) due to HPV infection. The tumor localization changed significantly to the clitoris/urethra site. Assuming that these limited data reflect the general trend in the incifdence of HPV-induced vulvar cancer, prophylactic HPV vaccination, which has been proven to be highly effective against anogenital disease, could make an important contribution to the reduction of the incidence of vulvar cancer in young women.