Vulvar Cancer in Young Women: Demographic Features and Outcome Evaluation

In the past 28 years, there has been a marked increase in the prevalence of in situ and invasive vulvar carcinoma with the increase of in situ disease occurring primarily in the under 65 age group and peaking at 40 to 49 years. The striking increase in the rates of premalignant lesions in women younger than 50 and other accumulating evidence suggests that the pathogenesis of vulvar cancer may be different in younger and older women. To investigate whether the pathogenesis may be different in these 2 age groups, this retrospective review evaluated prognostic and environmental risk factors associated with squamous cell vulvar cancer in a population of women at age 45 years or younger. The study population was comprised of 56 patients who were diagnosed with the cancer between 1994 and 2006. Their median age was 38 (range: 19-45). Demographic data that were collected and analyzed included a history of smoking, human papillomavirus infection and immunosuppression, and vulvar intraepithelial neoplasia. The median follow-up period was 25.3 months. Stage I disease was identified in 50% (28/56) of the patients. A history of smoking was found in 77% of the cases. In addition to being smokers, women with advanced disease (stage III and IV) had human papillomavirus infection (40%), vulvar intraepithelial neoplasia (46.7%), and were immunocompromised (6.7%). Symptoms longer than 12 months were present in 47% of patients with advanced stage disease. No significant relationship was found between the duration of symptoms and stage (P = 0.42) or positive lymph node metastases (P = 0.28). The disease recurred in 6 patients (10.7%) and three (5.4%) died of their disease. These findings of this small study are consistent with other reports suggesting that risk factors for vulvar cancer are different among younger women compared to the general, older vulvar cancer population. The majority of the risk factors associated with vulvar cancer in younger women appear to be modifiable.