Potential delay in the diagnosis of vulvar cancer and associated risk factors in women treated in German gynecological practices.

Jennifer Muigai,Louis Jacob,Karel Kostev,Konstantinos Dinas,Matthias Kalder

doi:10.18632/oncotarget.23848

Abstract

The goal of this study was to estimate a potential delay in the diagnosis of vulvar cancer and identify associated risk factors in women treated in gynecological practices in Germany. The current study sample included 1,652 women from 218 gynecological practices who received an initial diagnosis of vulvar cancer (ICD 10: C51) between January 2000 and December 2015 (index date). After applying several exclusion criteria, 505 non-cancer controls were matched (1:1) to 505 vulvar cancer cases based on age, health insurance status, and index date. The primary outcome was the delay in vulvar cancer diagnosis in women who had received an initial diagnosis of diseases of Bartholin's gland, inflammation of vagina and vulva, or other specified noninflammatory disorders of vulva, including atrophy, hypertrophy, and cyst. A logistic regression model was used to estimate the association between vulvar cancer and pre-defined diagnoses. The mean age was 60.8 years (SD = 15.6 years), and 4.8% of women had private health insurance coverage. Inflammation of vagina and vulva was diagnosed 328 days (SD = 95 days) prior to the detection of vulvar cancer. This delay was 186 days (SD = 196 days) in patients affected by diseases of Bartholin’s gland and 300 days (SD = 116 days) in those with other specified noninflammatory disorders of vulva including atrophy, hypertrophy, and cyst. The risk of vulvar cancer was positively associated with inflammation of vagina and vulva (OR = 2.28) and other specified noninflammatory disorders of vulva (OR = 5.39). The mean potential delay of vulvar cancer diagnosis ranged from 186 to 328 days.

Highlights

Vulvar cancer accounts for an important share of all gynecological malignancies [1]
The goal of this study was to estimate a potential delay in the diagnosis of vulvar cancer and identify associated risk factors in women treated in gynecological practices in Germany
After applying several exclusion criteria, 505 non-cancer controls were matched (1:1) to 505 vulvar cancer cases based on age, health insurance status, and index date

Summary

Introduction

Vulvar cancer accounts for an important share of all gynecological malignancies [1]. In Germany, 4% of gynecological cancers involve a cancer of the vulva [2]. A delay in the diagnosis of vulvar cancer has been reported in the literature and seems to result from a lack of specificity of symptoms at the early stages of the disease. Such delay has been found to vary from 6 to 22 months in studies performed in recent decades [4,5,6,7,8]. A German analysis including 208 patients affected by vulva disorders further showed that 63.9% of the population was diagnosed with inflammatory diseases [11] Another condition that shares similar symptoms with vulvar cancer is postmenopausal vulvovaginal atrophy (VVA), a disorder associated with a deficiency in estrogen. Vulvovaginal candidiasis, a common vulva disorder found in 30-50% of the population, may lead to a delay of vulvar cancer diagnosis [14]

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