Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, Texas.
Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, Texas.
Cancer Prev Res (Phila). 2022 Nov 1;15(11):777-784. doi: 10.1158/1940-6207.CAPR-22-0086.
The human papillomavirus (HPV) vaccine was indicated for the prevention of vulvovaginal cancers in 2008, but its impact on the incidence of vulvar cancers within the US is unknown. To determine this, we conducted a secondary analysis of 88,942 vulvar cancer cases among women 20+ years old using the US Cancer Statistics 2001-2018 databases. Data were stratified by tumor behavior (in situ or invasive), age (20-44, 45-64, 65+ years old), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), and US census region (Northeast, South, Midwest, West), and incidence rates and average annual percentage changes (AAPC) were calculated by group. Reversing previous trends, the incidence of vulvar carcinoma in situ significantly decreased between 2001 and 2018 among women from all age groups, races/ethnicities, and regions (combined AAPC, -4.3; 95% confidence interval (CI), -4.7 to -3.8). The incidence of invasive vulvar squamous cell carcinoma decreased significantly among 20- to 44-year-old women (AAPC, -0.8; 95% CI, -1.3 to -0.3), but significantly increased among those 45 to 64 (AAPC, 2.3; 95% CI, 1.8-2.8) and 65+ years old (AAPC, 1.2; 95% CI, 1.1-1.4). Regardless of tumor behavior, incidence was highest among non-Hispanic Whites and the Midwest region. Overall, the significant declines in vulvar carcinoma in situ among all ages, as well as invasive vulvar cancer among younger women, are encouraging and complement other recent data suggesting HPV vaccinations are already reducing anal and cervical cancer incidence. Over time, further declines in vulvar carcinoma incidence are likely as uptake and completion rates of the HPV vaccine increase in the US.
We found evidence that HPV vaccinations likely contributed to a decrease in the incidences of vulvar carcinoma in situ and invasive vulvar carcinoma among 20- to 44-year-old women between 2001 and 2018. Our data add to the growing evidence that HPV vaccinations are reducing the incidence of HPV-related anogenital cancers.
本研究旨在确定 HPV 疫苗的应用是否会对美国的外阴癌发病情况产生影响。方法：我们使用美国癌症统计 2001-2018 年数据库，对 88942 例 20 岁以上女性的外阴癌病例进行了二次分析。数据按肿瘤行为（原位或浸润性）、年龄（20-44、45-64、65 岁以上）、种族/族裔（非西班牙裔白人、非西班牙裔黑人、西班牙裔）和美国人口普查区（东北部、南部、中西部、西部）进行分层，并计算了各组的发病率和平均年百分比变化（AAPC）。结果：与之前的趋势相反，2001 年至 2018 年间，所有年龄组、种族/族裔和地区的外阴癌原位癌发病率均呈显著下降趋势（综合 AAPC，-4.3；95%置信区间[CI]，-4.7 至-3.8）。20-44 岁女性浸润性外阴鳞癌发病率显著下降（AAPC，-0.8；95%CI，-1.3 至-0.3），45-64 岁女性（AAPC，2.3；95%CI，1.8-2.8）和 65 岁以上女性（AAPC，1.2；95%CI，1.1-1.4）发病率显著上升。无论肿瘤行为如何，非西班牙裔白人和中西部地区的发病率均最高。结论：总之，所有年龄段外阴癌原位癌的显著下降，以及年轻女性浸润性外阴癌的发病率下降，令人鼓舞，并补充了其他最近的数据，表明 HPV 疫苗接种已经降低了肛门和宫颈癌的发病率。随着 HPV 疫苗在美国的接种率和完成率的提高，预计未来外阴癌的发病率将进一步下降。
