Vulval cancer risk factors

Prevention

Preventable cases of vulval cancer, UK

HPV

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

Not well understood

Vulval cancer risk factors are not well understood, mainly because this cancer is relatively rare

40% of vulval cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Vulval cancer risk is associated with a number of risk factors.[2,3]

Vulval 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)
  • Human papillomavirus (HPV) type 16
  • Human immunodeficiency virus (HIV)
  • HPV type 18, HPV type 33
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-

International Agency for Research on Cancer (IARC) and The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications. Find out more about IARC and WCRF/AICR classifications.

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Human papillomavirus (HPV) type 16 is classified by the International Agency for Research on Cancer (IARC) as a cause of vulval cancer, and HPV types 18 and 33 are classified as probable causes of vulval cancer, based on limited evidence.[1]

35% of vulval cancer cases in Europe are HPV-positive, a meta-analysis showed.[2] 81% of vulval intraepithelial neoplasia (VIN) cases in Europe are HPV-positive.[2] HPV type 16 is the most common type in vulval cancer cases worldwide (32%), followed by HPV types 33 (5%) and 18 (4%).[2] Vulval cancer cases are more likely to be HPV-positive in younger women.[2]

Vulval cancer risk is higher in women with genital warts, versus women without, a cohort study showed.[3] This is probably due to co-infection with high-risk HPV types (genital warts are caused by low-risk HPV types).[3]

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Human immunodeficiency virus (HIV) is classified by the International Agency for Research on Cancer (IARC) as a probable cause of vulval cancer, based on limited evidence.[1]

Vulval/vaginal cancer risk is 6.5 times higher in people with HIV/AIDS compared with the general population, a meta-analysis showed.[2] This is probably due to co-infection with, and reduced capacity to clear, Human papillomavirus (HPV).[2,3]

Vulval/vaginal cancer risk among people with HIV does not vary by level of immunosuppression, a cohort study showed.[4] Vulval/vaginal cancer risk among people with HIV has increased over time (probably related to changing HPV prevalence), a cohort study showed.[5]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans. Volumes 1 to 105* Accessed October 2014.
  2. 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.
  3. Shiels MS, Pfeiffer RM, Gail MH, et al. Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst 2011;103(9):753-62.
  4. Chaturvedi AK, Madeleine MM, Biggar RJ, et al. Risk of human papillomavirus-associated cancers among persons with AIDS. J Natl Cancer Inst 2009;101(16):1120-30.
  5. Shiels MS, Pfeiffer RM, Gail MH, et al. Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst 2011;103(9):753-62.
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Vulval cancer develops in 9% of women with untreated high-grade vulval intraepithelial neoplasia (VIN), 1-8 years after their VIN diagnosis, a systematic review showed.[1]

Vulval/vaginal cancer risk is 4-8 times higher in cervical cancer survivors, cohort studies have shown.[2-4] Vulval cancer risk is 2-6 times higher in women with previous cervical intraepithelial neoplasia, cohort studies have shown.[5-7]

Vulval cancer risk is higher in women whose sister or mother has/had cervical squamous cell carcinoma, a cohort study showed.[8]

The association between cervical and vulval cancers is probably mainly due to shared risk factors (e.g. Human papillomavirus (HPV)).

References

  1. van Seters M, van Beurden M, de Craen AJ. Is the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322 published patients. Gynecol Oncol 2005;97(2):645-51.
  2. Chaturvedi AK, Kleinerman RA, Hildesheim A, et al. Second cancers after squamous cell carcinoma and adenocarcinoma of the cervix. J Clin Oncol 2009;27(6):967-73.
  3. 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.
  4. Balamurugan A, Ahmed F, Saraiya M, et al. Potential role of human papillomavirus in the development of subsequent primary in situ and invasive cancers among cervical cancer survivors. Cancer 2008;113(10 Suppl):2919-25.
  5. Edgren G, Sparen P. Risk of anogenital cancer after diagnosis of cervical intraepithelial neoplasia: a prospective population-based study. Lancet Oncol 2007;8(4):311-6.
  6. 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.
  7. Jakobsson M, Pukkala E, Paavonen J, et al. Cancer incidence among Finnish women with surgical treatment for cervical intraepithelial neoplasia, 1987-2006. Int J Cancer 2011;128(5):1187-91.
  8. Hussain SK, Sundquist J, Hemminki K. Familial clustering of cancer at human papillomavirus-associated sites according to the Swedish Family-Cancer Database. Int J Cancer 2008;122(8):1873-8.
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Vulval cancer and vulval/vaginal cancer risk is higher in women with systemic lupus erythematosus Open a glossary item,[1-4] or psoriasis,[5] cohort studies have shown.

References

  1. Bernatsky S, Ramsey-Goldman R, Labrecque J, et al. Cancer risk in systemic lupus: an updated international multi-centre cohort study. J Autoimmun 2013;42:130-5.
  2. Parikh-Patel A, White RH, Allen M, et al. Cancer risk in a cohort of patients with systemic lupus erythematosus (SLE) in California. Cancer Causes Control 2008;19(8):887-94.
  3. Chen YJ, Chang YT, Wang CB, et al. Malignancy in systemic lupus erythematosus: a nationwide cohort study in Taiwan. Am J Med 2010;123(12):1150.e1-6.
  4. Dreyer L, Faurschou M, Mogensen M, et al. High incidence of potentially virus-induced malignancies in systemic lupus erythematosus: a long-term followup study in a Danish cohort. Arthritis Rheum 2011;63(10):3032-7.
  5. Beyaert R, Beaugerie L, Van Assche G, et al. Cancer risk in immune-mediated inflammatory diseases (IMID). Mol Cancer 2013;12(1):98.
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Vulval cancer risk is 7.6 times higher in solid organ transplant recipients compared with the general population, a cohort study showed.[1] Vulval/vaginal cancer risk is up to 23 times higher in organ transplant recipients compared with the general population, a meta-analysis showed;[3] this may be limited to kidney recipients.[2] This may be due to reduced capacity to clear Human papillomavirus (HPV) infection.[3]

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Vulval cancer risk is higher in ever-smokers compared with never-smokers, a case-control study showed.[1]

Progression from vulval neoplasia to vulval cancer is associated with smoking, a cohort study showed.[2]

Cervical cancer studies (which are the best currently-available proxy for vulval cancer in this context) indicate smoking may relate to risk of Human papillomavirus (HPV)-associated cancers because it affects likelihood of contracting or clearing HPV infection, or affects cancerous progression in HPV-infected cells.

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