Risk Factors and Prevention

A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.

The following factors may raise a woman’s risk of developing vulvar cancer:

Age. The majority of women diagnosed with vulvar cancer are older than 50. However, a significant percentage (15%) of women under 40 develop vulvar cancer. Generally, vulvar cancer in younger women is associated with HPV infection and smoking. Vulvar cancer in older women is most often associated with lichen sclerosus (a rare skin condition; see below) or mutations (changes) in certain genes.

HPV infection. HPV is most often spread from one person to another during sexual intercourse. There are many types or strains of HPV, and some are linked with genital or anal cancer in men and women. HPV may be responsible for an about one-third to two-thirds of vulvar cancers. Many types of cancer caused by HPV are associated with precancerous conditions (changes in cells that may, but do not always, become cancer) that develop before the cancer.

Smoking. Smoking may increase a woman’s risk of developing vulvar cancer if she has HPV.

Immune system deficiency. Women with lowered immune systems have a higher risk of developing vulvar cancer. A lowered immune system can be caused by immune suppression from corticosteroid medications, organ transplantation, or treatment for other types of cancer or from human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS). When a woman has a lowered immune system, her body is more likely to develop infections, including HPV.

Lichen sclerosus. This condition affects the vulvar skin, making it thin and itchy. About 4% of women with lichen sclerosus develop vulvar cancer.

Precancerous conditions. Precancerous conditions of the vulva, cervix, or vagina, or melanoma elsewhere on the body, can increase a woman’s risk of developing vulvar cancer.

Prevention and Early Detection

All women should have an annual gynecologic examination. During this exam, the doctor will take a family medical history and perform a general physical examination of the pelvis, during which the doctor will feel a woman’s uterus, vagina, cervix, and other reproductive organs to check for any unusual changes. Regular pelvic examinations can help detect cancer or precancerous conditions at an early stage. In addition, research has shown that certain factors can help prevent vulvar cancer.

• Delaying first sexual intercourse until the late teens or older
  
  
• Avoiding sexual intercourse with multiple partners
  
  
• Avoiding sexual intercourse with someone who has had many partners
  
  
• Practicing safe sex, including condom use (although condoms cannot fully protect against HPV)
  
  
• Having regular gynecologic examinations to detect and treat precancerous conditions
  
  
• Not starting to smoke
  
  
• Quitting smoking, if a smoker

In 2008, the vaccine used to prevent cervical cancer for girls and women between ages 9 and 26 was also approved to prevent vulvar cancer. It prevents infection by the four most common strains (types) of HPV. The vaccine does not protect people who are already infected with HPV. For more information on the HPV vaccine, read the ASCO Expert Corner: HPV Vaccination for Cervical Cancer. People are encouraged to talk with their doctors for more information about the HPV vaccine.