Vulval cancer incidence, mortality and survival in England: age-related trends

Authors

  • J Lai,

    Corresponding author
    1. Public Health England (PHE) Knowledge and Intelligence Team (East Midlands) (formerly Trent Cancer Registry), Sheffield, UK
    • Correspondence: J Lai, Public Health England (PHE) Knowledge and Intelligence Team (East Midlands) (formerly Trent Cancer Registry), 5 Old Fulwood Road, Sheffield S10 3TG, UK. Email jenniferlai@nhs.net

    Search for more papers by this author
  • R Elleray,

    1. Public Health England (PHE) Knowledge and Intelligence Team (East Midlands) (formerly Trent Cancer Registry), Sheffield, UK
    Search for more papers by this author
  • A Nordin,

    1. East Kent Hospitals University NHS Foundation Trust, Margate, UK
    2. Gynaecological Site Specific Clinical Reference Group (SSCRG), National Cancer Intelligence Network (NCIN), London, UK
    Search for more papers by this author
  • L Hirschowitz,

    1. Gynaecological Site Specific Clinical Reference Group (SSCRG), National Cancer Intelligence Network (NCIN), London, UK
    2. Birmingham Women's NHS Trust, Birmingham, UK
    Search for more papers by this author
  • B Rous,

    1. National Cancer Registration Service (Eastern) (formerly Eastern Cancer Registry and Information Centre, ECRIC), Cambridge, UK
    Search for more papers by this author
  • C Gildea,

    1. Public Health England (PHE) Knowledge and Intelligence Team (East Midlands) (formerly Trent Cancer Registry), Sheffield, UK
    Search for more papers by this author
  • J Poole

    1. Public Health England (PHE) Knowledge and Intelligence Team (East Midlands) (formerly Trent Cancer Registry), Sheffield, UK
    2. Gynaecological Site Specific Clinical Reference Group (SSCRG), National Cancer Intelligence Network (NCIN), London, UK
    Search for more papers by this author

Abstract

Objective

To explore the trends and age characteristics of vulval cancer incidence, mortality, survival and stage of disease.

Design

Retrospective population-based observational study based on cancer registry and Office for National Statistics data.

Setting

England.

Population

All women diagnosed with vulval cancer, defined by the site of the tumour (ICD-10 code C51).

Methods

Including all C51 cases, Poisson regression was used to test for trends in incidence and mortality rates, and generalised linear modelling was used to test for trends in relative survival. Excluding women with melanomas, basal cell carcinomas and Paget disease, stage was investigated as a percentage of staged data by age.

Main outcome measures

Age-standardised incidence and mortality rates, relative survival rates and stage of disease at diagnosis.

Results

From 1990, there was a statistically significant increase in overall incidence (P = 0.018) and decrease in mortality (P < 0.001). In addition, there were statistically significant increases in overall survival (1-year, P < 0.001; 5-year, P < 0.001). However, from 1990, incidence increased in women aged 20–39 years (P = 0.002), 40–49 and 50–59 years (both P < 0.001) and 60–69 years (P = 0.030) and decreased in women aged 80 years and above (P < 0.001). There were statistically significant decreases in mortality in women aged ≥60 years (P < 0.001), and statistically significant increases in 1-year survival in women aged ≥40 years (P ≤ 0.047) and in 5-year survival in women aged 40–49 and ≥60 years (P ≤ 0.011). Stage patterns by age highlight diagnosis at an earlier stage in younger women and more advanced stage diagnosis in older women.

Conclusion

Survival from vulval cancer has improved and mortality has decreased since 1990. The overall incidence of disease has increased as a result of more new diagnoses in the under 70-year age group.

Ancillary