1. African American women were more likely to present with vulvar cancer at a younger age compared to white women.
2. Among women ≥ 60 years of age, African Americans had lower vulvar cancer related mortality.
Evidence Rating Level: 2 (Good)
Study Rundown: This study explored the epidemiology of vulvar cancer and found that compared to white women, African Americans were more likely to be younger and have more advanced disease upon diagnosis, yet experienced lower rates of vulvar cancer related mortality compared to white women. Prior cross-sectional and retrospective cohort studies have failed to identify racial differences in mortality rate.
Strengths of this study include a large sample size, detailed data on cancer-related variables and long-term follow-up. Limitations include a retrospective design and variations in treatment standards between providers and facilities. Future studies might evaluate trends in mortality over time and assess differences in vulvar cancer related mortality by HPV status.
In-Depth [retrospective cohort study]: This study analyzed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) registry to evaluate differences in mortality trends of 7,363 white and 610 African American (AA) women who were diagnosed with histology-confirmed vulvar cancer between 1973 and 2009.
Mean age of diagnosis was 57 years for AA and 67 years for whites. AA women were more likely to have regional (26.7% vs 24.6%) and distant metastasis (5.6% vs. 3.6%) compared with white women and were less likely to have well-differentiated cancer (15.9% vs. 21.1%). AA women were less likely to be treated with surgery alone (70.2% vs. 76.1%) and more likely to receive radiotherapy or combination therapy. Overall, AA women ≥ 60 years had lower hazards of vulvar cancer related mortality in 1990-1999 and 2000-2009 (HR 0.39, CI 0.22-0.70).
By Denise Pong, MPH and Leah Hawkins, MD, MPH
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