Saraiya Mona, Watson Meg, Wu Xiaocheng, King Jessica B, Chen Vivien W, Smith Jennifer S, Giuliano Anna R
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Cancer. 2008 Nov 15;113(10 Suppl):2865-72. doi: 10.1002/cncr.23759.
The human papillomavirus (HPV) vaccine has been shown to prevent precancerous lesions of the vulva with the potential to prevent a percentage of vulvar cancers. To provide a baseline picture before HPV vaccine implementation, the authors described vulvar cancer epidemiology by age, race, ethnicity, and histology in the US.
The authors examined incidence data from 39 population-based cancer registries that met high-quality data standards from 1998 to 2003, covering approximately 83% of the US population. They limited their analysis to in situ and invasive vulvar squamous cell carcinomas (SCCs). In situ vulvar cancers did not include vulvar intraepithelial neoplasia type 3 (VIN 3).
SCC accounted for 77% of in situ cases and 75% of invasive vulvar cancers, an annual burden of 1498 in situ and 2266 invasive SCC vulvar cancers. Greater than 75% of the in situ and invasive SCCs had no specific histology identified. White women had the highest rates of vulvar cancer; the incidence rates of invasive vulvar SCC among black women and Hispanic women were approximately one-third lower than for their counterparts (white women and non-Hispanic women, respectively). For women aged <50 years, the age-specific rates of invasive SCC were approximately the same among whites and blacks. Increases in rates after age 50 years, however, were noted to be more rapid among white than among black women.
Distinct age-specific incidence rate patterns of invasive vulvar SCC by race and ethnicity and the higher incidence rates observed among white women compared with women of other races and ethnicities were opposite to patterns noted for cervical cancer. Underestimations of the burden of in situ vulvar cancers were a result of the inability to examine VIN 3 in the authors' data. Encouragement of cancer registries to report and submit VIN 3 data and more research on data quality will allow a thorough assessment of the impact of HPV vaccine by providing a basis for examining the true burden and quality of these precancerous vulvar tumors. Increased documentation of histologic subtypes in pathology reports and in cancer registry data can help differentiate the burden ofHPV-associated types from non-HPV-associated types of vulvar cancers.
人乳头瘤病毒（HPV）疫苗已被证明可预防外阴癌前病变，有可能预防一定比例的外阴癌。为了在HPV疫苗实施前提供一个基线情况，作者按年龄、种族、民族和组织学描述了美国外阴癌的流行病学情况。
作者研究了1998年至2003年期间39个符合高质量数据标准的基于人群的癌症登记处的发病率数据，这些登记处覆盖了约83%的美国人口。他们将分析限于原位和浸润性外阴鳞状细胞癌（SCC）。原位外阴癌不包括3级外阴上皮内瘤变（VIN 3）。
SCC占原位病例的77%和浸润性外阴癌的75%，原位SCC外阴癌的年负担为1498例，浸润性SCC外阴癌为2266例。超过75%的原位和浸润性SCC未明确具体组织学类型。白人女性外阴癌发病率最高；黑人女性和西班牙裔女性浸润性外阴SCC的发病率分别比其对应人群（白人女性和非西班牙裔女性）低约三分之一。对于年龄<50岁的女性，白人女性和黑人女性浸润性SCC的年龄别发病率大致相同。然而，50岁以后，白人女性的发病率增长速度比黑人女性更快。
不同种族和民族浸润性外阴SCC的年龄别发病率模式不同，与其他种族和民族女性相比，白人女性的发病率更高，这与宫颈癌的模式相反。原位外阴癌负担的低估是由于作者的数据无法检查VIN 3。鼓励癌症登记处报告和提交VIN 3数据，并对数据质量进行更多研究，将通过为检查这些癌前外阴肿瘤的真实负担和质量提供基础，从而全面评估HPV疫苗的影响。病理报告和癌症登记数据中组织学亚型记录的增加有助于区分HPV相关类型和非HPV相关类型外阴癌的负担。
