Vaginal cancer risk factors

Prevention

Preventable cases of vaginal cancer, UK

HPV

Vaginal cancer cases linked to human papillomavirus (HPV) infection, UK

63% of vaginal cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Vaginal cancer risk is associated with a number of risk factors.[2]

Vaginal Cancer Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • Diethylstilbestrol (DES) exposure in utero
  • Human papillomavirus (HPV) type 16
  • Human immunodeficiency virus (HIV)
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International Agency for Research on Cancer (IARC) classification. World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classification does not include vaginal cancers.

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Human papillomavirus Open a glossary item type 16 (HPV16) is classified by the International Agency for Research on Cancer (IARC) as a cause of vaginal cancer.[1] An estimated 63% of vaginal cancers in the UK are linked to HPV.[2]

Vaginal cancer risk is 5 times higher in women with HPV16 antibodies versus those without, a case-control study showed.[3] HPV16 is present in 59% of vaginal cancers, a cross-sectional study showed.[4]

Vaginal intraepithelial neoplasia (VAIN) Open a glossary item risk is 5 times higher in women with HPV16 antibodies versus those without, a case-control study showed.[3] HPV16 is present in 59% of high-grade VAIN (VAIN2/3), a cross-sectional study showed.[4]

HPV of any type is present in 74% of vaginal cancers and 96% of high-grade VAIN, a cross-sectional study showed.[4] Vaginal cancer risk is not associated with HPV18, but VAIN risk is twice higher in women with HPV18 antibodies versus those without, a case-control study showed.[3]

VAIN risk is reduced by 95-100% in girls who receive HPV vaccination when they are HPV-negative, versus unvaccinated girls, randomised controlled trials (RCTs) Open a glossary item have shown.[5-7]

HPV-related high-grade VAIN/vulval intraepithelial neoplasia (combined) risk is not reduced by HPV vaccination in girls who receive the vaccine after they have definitely/probably been exposed to HPV, versus unvaccinated girls, meta-analyses of RCTs have shown.[8,9]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer Inst 2011;103(24):1827-39.
  2. Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S77-81.
  3. Carter JJ, Madeleine MM, Shera K, et al. Human Papillomavirus 16 and 18 L1 Serology Compared across Anogenital Cancer Sites. Cancer Res 2001;61(5):1934-40.
  4. Alemany L, Saunier M, Tinoco L, et al. Large contribution of human papillomavirus in vaginal neoplastic lesions: a worldwide study in 597 samples. Eur J Cancer 2014;50(16):2846-54.
  5. FUTURE I/II Study Group, Dillner J, Kjaer SK, Wheeler CM, et al. Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial. Brit Med J 2010;341.
  6. Muñoz N, Kjaer SK, Sigurdsson K, et al. Impact of Human Papillomavirus (HPV)-6/11/16/18 Vaccine on All HPV-Associated Genital Diseases in Young Women. J Natl Cancer Inst 2010;102(5):325-39.
  7. Joura EA, Leodolter S, Hernandez-Avila M, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet 2007;369(9574):1693-702.
  8. Couto E, Sæterdal I, Juvet LK, Klemp M. HPV catch-up vaccination of young women: a systematic review and meta-analysis. BMC Public Health 2014;14:867.
  9. Miltz A, Price H, Shahmanesh M, et al. Systematic review and meta-analysis of L1-VLP-based human papillomavirus vaccine efficacy against anogenital pre-cancer in women with evidence of prior HPV exposure. PLoS One 2014;9(3):e90348.
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Human immunodeficiency virus (HIV) is classified by the International Agency for Research on Cancer (IARC) as a probable cause of vaginal cancer, based on limited evidence.[1] People with HIV infection often also have human papillomavirus (HPV), and HIV may facilitate initiation or persistence of HPV infection; HIV-related UK vaginal cancer cases are included in the HPV-attributable proportion above.[2,3]

Vaginal cancer risk is 9 times higher in women with HIV compared with the general population, a meta-analysis has shown.[4]

Some studies show a particularly strong relationship for women under 30 years old.[5,6]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer Inst 2011;103(24):1827-39.
  2. Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S77-81.
  3. Parkin DM. 11. Cancers attributable to infection in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S49-56.
  4. Shiels MS, Cole SR, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 2009;52(5):611-22.
  5. Frisch M, Biggar RJ, Goedert JJ. Human Papillomavirus-Associated Cancers in Patients With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. J Natl Cancer Inst 2000;92(18):1500-10.
  6. Sitas F, Pacella-Norman R, Carrara H, et al. The spectrum of HIV-1 related cancers in South Africa. Int J Cancer 2000;88(3):489-92.
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Diethylstilbestrol (DES) exposure in utero is classified by the International Agency for Research on Cancer (IARC) as a cause of vaginal cancer.[1]

Vaginal clear cell adenocarcinoma (a rare subtype) risk is higher in women whose mothers took DES during pregnancy, cohort studies have shown.[2,3]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer Inst 2011;103(24):1827-39.
  2. Troisi R, Hatch EE, Titus-Ernstoff L, et al. Cancer risk in women prenatally exposed to diethylstilbestrol. Int J Cancer 2007;121(2):356-60.
  3. Verloop J, van Leeuwen FE, Helmerhorst TJ, et al. Cancer risk in DES daughters. Cancer Causes Control 2010;21(7):999-1007.
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Vaginal intraepithelial neoplasia (VAIN) risk is higher in women who have ever had genital warts, versus those who have not, a cross-sectional study showed.[1]

Genital warts are associated with HPV6 and HPV11 (human papillomavirus) infection.[1]

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Vaginal intraepithelial neoplasia (VAIN) risk is 11 times higher in organ transplant recipients compared with the general population, a cohort study showed.[1] Vaginal cancer risk is not associated with organ transplant receipt, a cohort study showed; there was a non-significant risk increase.[2]

Organ transplant recipients have higher human papillomavirus (HPV) risk, probably due to their immunosuppressant medication use.[3]

References

  1. Madeleine MM, Finch JL, Lynch CF, et al. HPV-related cancers after solid organ transplantation in the United States. Am J Transplant 2013;13(12):3202-9.
  2. Engels EA, Pfeiffer RM, Fraumeni JF Jr, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA 2011;306(17):1891-901.
  3. Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007;370(9581):59-67.
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Vaginal (or vulval and vaginal combined) cancer risk is higher in women with previous cervical cancer or cervical intraepithelial neoplasia,[1-7] other anogenital cancer,[8] or skin squamous cell carcinoma.[9]

These cancers are associated with human papillomavirus (HPV) infection.

References

  1. Evans HS, Newnham A, Hodgson SV, et al. Second primary cancers after cervical intraepithelial neoplasia III and invasive cervical cancer in Southeast England. Gynecol Oncol 2003;90(1):131-36.
  2. Viikki M, Pukkala E, Hakama M. Risk of endometrial, ovarian, vulvar, and vaginal cancers after a positive cervical cytology followed by negative histology. Obstet Gynecol 1998;92(2):269-73.
  3. Strander B, Andersson-Ellström A, Milsom I, et al. Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study. Brit Med J 2007;335(7629):1077.
  4. Edgren G, Sparén P. Risk of anogenital cancer after diagnosis of cervical intraepithelial neoplasia: a prospective population-based study. Lancet Oncol 2007;8(4):311-16.
  5. Kalliala I, Anttila A, Pukkala E, et al. Risk of cervical and other cancers after treatment of cervical intraepithelial neoplasia: retrospective cohort study. Brit Med J 2005;331(7526):1183-85.
  6. Jégu J, Colonna M, Daubisse-Marliac L, et al. The effect of patient characteristics on second primary cancer risk in France. BMC Cancer 2014;14:94.
  7. Gaudet M, Hamm J, Aquino-Parsons C. Incidence of ano-genital and head and neck malignancies in women with a previous diagnosis of cervical intraepithelial neoplasia. Gynecol Oncol 2014;134(3):523-6.
  8. Frisch M, Olsen JH, Melbye M. Malignancies that occur before and after anal cancer: clues to their etiology. Am J Epidemiol 1994;140(1):12-9.
  9. Wassberg C, Thörn M, Yuen J, et al. Second primary cancers in patients with squamous cell carcinoma of the skin: A population-based study in Sweden. Int J Cancer 1999;80(4):511-15.
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Cancer Statistics Explained

See information and explanations on terminology used for statistics and reporting of cancer, and the methods used to calculate some of our statistics.

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