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Kaderly Rasmussen EL, Hannibal CG, Hertzum-Larsen R, Kjær SK, Baandrup L. Biopsy-verified vulvar lichen sclerosus and the risk of non-vulvar cancer: A nationwide cohort study. Int J Cancer 2024. [PMID: 39016007 DOI: 10.1002/ijc.35101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024]
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory mucocutaneous disease known to be associated with human papillomavirus-independent vulvar squamous cell carcinoma. Evidence on the association with other types of cancer, however, is sparce. We conducted a large nationwide cohort study examining the incidence of non-vulvar cancers among women with biopsy-verified VLS compared with the general female population. By using the nationwide Pathology Registry, we identified all women in Denmark with a biopsy-verified VLS diagnosis during 1978-2019 (n = 16,921). The cohort was followed up in the Danish Cancer Registry until 2022 for a subsequent non-vulvar cancer diagnosis. Standardized incidence ratios (SIRs) were computed with 95% confidence intervals (CIs) as relative risk estimates of all specific non-vulvar cancer sites. Compared with general female population rates, women with biopsy-verified VLS had decreased rates of several non-vulvar cancers, including HPV-related cancers (combined estimate: SIR = 0.5; 95% CI: 0.3-0.7), and lung (SIR = 0.6; 95% CI: 0.5-0.7), liver (SIR = 0.5; 95% CI: 0.2-0.9), and thyroid cancer (SIR = 0.5; 95% CI: 0.3-0.9). The decreased SIRs tended to sustain throughout the follow-up period following the VLS diagnosis. This large nationwide cohort study shows that women with biopsy-verified VLS may have a long-term reduced risk of developing HPV-related (cervical, vaginal, oropharyngeal, and anal) and smoking-associated cancers (lung, liver, and cervical) as well as thyroid cancer. Future studies focusing on the mechanisms behind the decreased cancer risk are needed.
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Affiliation(s)
| | | | | | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Baandrup
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
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Preti M, Borella F, Ferretti S, Caldarella A, Corazza M, Micheletti L, De Magnis A, Borghi A, Salvini C, Gallio N, Pasquero G, Vieira-Baptista P, Selk A, Benedetto C, Rosso S. Genital and extragenital oncological risk in women with vulvar lichen sclerosus: A multi-center Italian study. Maturitas 2023; 175:107767. [PMID: 37302181 DOI: 10.1016/j.maturitas.2023.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 06/13/2023]
Abstract
Vulvar lichen sclerosus is a chronic inflammatory disease involving vulvar skin. The risk of developing invasive vulvar cancer for women with LS is reported in the literature, but the risk of extra-vulvar tumors has been under-investigated. This multicentric study aims to estimate the risk of developing cancers in a cohort of women with a diagnosis of vulvar lichen sclerosus. METHODS A cohort of women diagnosed with and treated for vulvar lichen sclerosus in three Italian gynecological and dermatological clinics (Turin, Florence, and Ferrara) was retrospectively reviewed. Patient data were linked to cancer registries of the respective regions. The risk of subsequent cancer was estimated by dividing the number of observed and expected cases by the standardized incidence ratio. RESULTS Among 3414 women with a diagnosis of vulvar lichen sclerosus corresponding to 38,210 person-years of follow-up (mean 11.2 years) we identified 229 cancers (excluding skin cancers and tumors present at the time of diagnosis). We found an increased risk of vulvar cancer (standardized incidence ratio = 17.4; 95 % CL 13.4-22.7), vaginal cancer (standardized incidence ratio = 2.7; 95 % CL 0.32-9.771), and oropharyngeal cancer (standardized incidence ratio = 2.5; 95 % CL 1.1-5.0), and a reduced risk of other gynecological tumors (cervical, endometrial, ovarian) and breast cancer. CONCLUSIONS Patients with vulvar lichen sclerosus should undergo annual gynecological check-up with careful evaluation of the vulva and vagina. The increased risk of oropharyngeal cancer also suggests the need to investigate oropharyngeal cavity symptoms and lesions in patients with vulvar lichen sclerosus.
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Affiliation(s)
- Mario Preti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy.
| | - Stefano Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, and Local Health Authority, 44121 Ferrara, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical, and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Leonardo Micheletti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Angelina De Magnis
- Department of Gynecology and Obstetrics, University of Florence, Florence, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Camilla Salvini
- Dermatology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Niccolò Gallio
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Giorgia Pasquero
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Pedro Vieira-Baptista
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Amanda Selk
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, "City of Health and Science University Hospital", University of Turin, 10126 Turin, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U, City of Health and Science University Hospital, Turin, Italy
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Moreno-Vílchez C, Llobera-Ris C, Torrecilla-Vall-Llossera C, Notario J, Figueras-Nart I. Lichen sclerosus and its association with cancer: a retrospective cohort study. Int J Dermatol 2023; 62:e84-e85. [PMID: 35394068 DOI: 10.1111/ijd.16218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Carlos Moreno-Vílchez
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Claudia Llobera-Ris
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | | | - Jaime Notario
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Ignasi Figueras-Nart
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
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