title: Demographic, clinical, and treatment trends among women diagnosed with vulvar cancer in the United States.
abstract: OBJECTIVE
  Describe the treatment and survival patterns among a population-based sample of vulvar cancer patients diagnosed in the United States in 1999.
  
  
  METHODS
  Cases were identified for the National Cancer Institute's Patterns of Care Study (POC) using the Surveillance, Epidemiology, and End Results Program (SEER). A stratified random sample of non-Hispanic white, non-Hispanic black, and Hispanic women age 20 years and older was selected from cases reported by 11 SEER registries. Analyses of the association between vulvar cancer and key demographic, clinical, and hospital characteristics by stage were performed. Cox proportional hazards was used to estimate the odds of death due to cancer. All estimates were weighted, and analyses were conducted with SUDAAN.
  
  
  RESULTS
  Ninety percent of cases were diagnosed with in situ or early-stage invasive disease. Older patients were more likely to present at advanced stages. Twenty-five percent of women with Stage III-IV vulvar cancer received chemotherapy plus radiation. We noted widespread use of radical local excision among women with Stage I/II cancer, but 46-54% with invasive disease underwent a radical or total vulvectomy. Factors associated with cancer death were limited to age and stage. Women 75 years and older were at higher risk compared to women aged 20-49 years and the risk of death increased with advancing stage.
  
  
  CONCLUSIONS
  Vulvar cancer is diagnosed at early stages. Late-stage disease is associated with a significant increase in mortality. Radical surgery was still commonly performed in 1999. Radiation was more common in women diagnosed at late stage, while the use of chemoradiation remained limited.
authors.affiliation: University of Utah, Utah Cancer Registry, 650 Komas Drive, Suite 106B, Salt Lake City, Utah 84108, USA. Nan.Stroup@hsc.utah.edu
authors.forename: A M
authors.initials: AM
authors.lastname: Stroup
authors.forename: L C
authors.initials: LC
authors.lastname: Harlan
authors.forename: E L
authors.initials: EL
authors.lastname: Trimble
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014846:Vulvar Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016387:Women's Health / Q000208:ethnology