Analysis of the incidence and mortality of vulval cancer in women in South East England 1960-1999

Abstract

Objective: To investigate the age related trends in the incidence and mortality of vulval cancer in South East England between 1960 and 1999.

Methods: An analysis of systematically collected data by the Thames Cancer Registry from 26 health authorities in the Thames region. The study population included women diagnosed with vulval cancer in South East England between 1960 and 1999. The main outcome measures included changes in overall incidence of vulval cancer, as well as the change in incidence of vulval cancer in each 10 year age groups (25-80+) per 100,000 women in the 39 year study period. Changes in the incidence rate of vulval cancer per age group over time were determined by linear regression. Systematically collected data on mortality from the Office for National Statistics and Thames Cancer Registry were also analysed over the same time period and population comparing South East England to England as a whole.

Results: In women aged 80 years and above there was a rise in incidence; by 1.10 per 100,000 women per 5 year period (95% CI 0.364-1.844, P = 0.027). Women aged 60-69 experienced a decrease in incidence of vulval cancer; by 0.34 per 100,000 women in each 5 year calendar period (95% CI -0.502 to -0.176, P = 0.0065). The overall incidence in all age groups remained unchanged. There was no correlation between the percentage of deaths in South East England compared to England and year of death; correlation coefficient -0.0848, P = 0.60. There was a decrease in death rate in women 60 years and above over the latter 15 years of the study.

Conclusion: The overall rate of vulval cancer has remained unchanged. There have been changes in the age specific incidence in women aged 60-69 years and 80 years and above. Vulval cancer remains a rare disease. The rise in the older age groups is not easily explained by lifestyle. Challenges in the management of this condition include improving public education on earlier self referral, earlier detection and provision of appropriate care.