Risk Of Vaginal Cancer Research Articles

Risks of Second Primary Gynecologic Cancers following Ovarian Cancer Treatment in Asian Ethnic Subgroups in the United States, 2000-2016.

The differential occurrence of second primary cancers by race following ovarian cancer is poorly understood. Our objective was to determine the incidence of second primary gynecologic cancers (SPGC) following definitive therapy for ovarian cancer. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgroups. We identified 27,602 women ages 20 years and older and diagnosed with first primary epithelial ovarian cancer between 2000 and 2016 who received surgery and chemotherapy in 18 population-based Surveillance, Epidemiology and End Results Program registries. We compared the incidence of SPGC with expected incidence rates in the general population of women using estimated standardized incidence ratios (SIR) and 95% confidence intervals (CI). The incidence of SPGC was lower among White women (SIR = 0.73; 95% CI, 0.59-0.89), and higher among Black (SIR = 1.80; 95% CI, 0.96-3.08) and Asian/Pacific Islander (API) women (SIR = 1.83; 95% CI, 1.07-2.93). Increased risk of vaginal cancers was observed among all women, although risk estimates were highest among API women (SIR = 26.76; 95% CI, 5.52-78.2) and were also significant for risk of uterine cancers (SIR = 2.53; 95% CI, 1.35-4.33). Among API women, only Filipinas had significantly increased incidence of SPGC overall including both uterine and vaginal cancers. Risk of SPGC following treatment of ovarian cancer differs by race and ethnicity, with Filipina women having the highest rates of second gynecologic cancers among Asian women. Ensuring access and adherence to surveillance may mitigate ethnic differences in the early detection and incidence of second gynecologic cancers.

Abstract C020: Racial differences in the risks of second primary gynecologic cancers following chemotherapy for malignant ovarian tumors: Asian subgroups in the United States, 2000-2016

Abstract Objective: The incidence of ovarian cancer in the United States varies by race with the highest rates among white women but lower survival observed among black women and other racial and ethnic groups. These disparities in outcomes among women with ovarian cancer are not well understood, including the differential occurrence of second primary cancers according to race. Our objective was to measure racial differences in incidence of second primary gynecologic cancers (SPGC) among women with malignant ovarian tumors following treatment with chemotherapy. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgroups in the United States. Methods: We conducted a retrospective cohort study of women ages 20 years and older diagnosed with first primary malignant ovarian tumors treated with definitive surgery and chemotherapy between 2000 and 2016 from 18 population-based registries in the Surveillance, Epidemiology and End Results (SEER) Program. We collected demographic and clinical information on ovarian histologic subtypes, laterality, tumor grade, type of surgery and treatment with radiotherapy. Census tract-level sociodemographic characteristics of women were also described. The incidence of SPGC in our cohort was compared to expected incidence rates in the general population using age-and region-standardized incidence ratios (SIRs) and 95% confidence intervals (CI) for individual racial/ethnic groups. Results: Among 34,081 women with ovarian cancer, 74% were white, 6% were black, 8% were Asian/Pacific Islander (API) and 11% were Hispanic. Median age at diagnosis was lower among API and Hispanic women (54 years) compared to white (60 years) and black women (58 years). Most ovarian tumors were serous or endometrioid, although API women had a higher proportion of clear cell ovarian tumors (15%) compared to white (6%), black (5%) and Hispanic women (6%). Subgroups of API women also differed in distribution of ovarian tumor histology, grade, and age at diagnosis. Whereas incidence of SPGC was observed to be lower than expected among white women (SIR 0.72 CI 0.59-0.87), estimates were suggestive of higher than expected incidence among black (SIR 1.61, CI 0.88-2.71) and API women (SIR 1.64, CI 0.96-2.63), although confidence intervals included 1.0. Increased risk of vaginal cancers was observed among all women, although risk estimates were highest among API women (SIR 23.90, CI 4.93-69.84) and were also significant for risk of uterine cancers (SIR 2.28 CI 1.21-3.90). Among API women, only Filipinas had significantly increased incidence of SPGC overall including both uterine and vaginal cancers. Conclusions: Risk of SPGC following treatment of ovarian cancer differs by race. The increased incidence of secondary gynecological cancers observed in Asian women is driven largely by increased rates of uterine and vaginal cancers among Filipina women. Further research is warranted to understand the possible mechanism(s) underlying this observed disparity. Citation Format: Nita H Mukand, Ashwini N Zolekar, Naomi Y Ko, Gregory S Calip. Racial differences in the risks of second primary gynecologic cancers following chemotherapy for malignant ovarian tumors: Asian subgroups in the United States, 2000-2016 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C020.

The risk of vaginal cancer is associated with a history of cervical neoplasia.

Infection with high risk HPV is integral to the development of vaginal cancer, however what remains unclear is the proportion of women who develop vaginal cancer de-novo or as a complication of inadequate treatment of CIN. Incomplete excision of CIN at the time of hysterectomy results in persistence of intra-epithelial neoplasia at the vault of the vagina, known as VaIN.

A Common Clinical Dilemma: Management of Abnormal Vaginal Cytology and Human Papillomavirus Test Results.

Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (HPV) tests, and clinicians are faced with managing their abnormal results. Our objectives were to review the literature on vaginal cytology and high-risk HPV (hrHPV) testing and to develop guidance for the management of abnormal vaginal screening tests. An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted. The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that (1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and (2) in women for whom surveillance is recommended, e.g., women posttreatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors. Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.

Epidemiologic Evidence for Adverse Effects of DES Exposure during Pregnancy

Abstract This report summarizes the evidence regarding adverse effects of diethylstilbestrol (DES) administration during pregnancy. From the association in 1969 of in utero DES exposure with subsequent increased risk of vaginal cancer in young women, the report includes the state of evidence regarding in utero DES exposure with other female genital tract abnormalities, with male genital tract abnormalities, with subsequent adverse reproductive experiences, and, among the exposed mothers, with increased risk of breast and other gynecologic cancers.

VAGINAL CANCER FROM INTRAUTERINE EXPOSURE TO SYNTHETIC ESTROGENS

The risk of vaginal cancer among daughters of women who received estrogen during pregnancy has been calculated in the first prospective study reported to date (Lanier, A. P. et al., Mayo Clin. Proc., 48:793, 1973). Among nearly 24,000 children born at the Mayo Clinic obstetrics facilities, 1943 to 1959, no cancers were found among 404 females exposed to synthetic estrogens in the first trimester and traced to 13 to 29 years of age (median, 22 years). From this result it was estimated that the risk of developing vaginal or cervical clear-cell adenocarcinoma was no greater than seven per 1,000 by age 13, and was less than 13 per 1,000 by age 22. No such cancer was found among 400 females exposed in utero during other trimesters than the first. No excess of other cancers or of other diseases was found among the 804 live-born females or 877 males.