Prevalence of human papillomavirus types in invasive vulvar cancers and vulvar intraepithelial neoplasia 3 in the United States before vaccine introduction.
OBJECTIVE
The study aimed to determine the baseline prevalence of human papillomavirus (HPV) types in invasive vulvar cancer (IVC) and vulvar intraepithelial neoplasia 3 (VIN 3) cases using data from 7 US cancer registries.


METHODS
Registries identified eligible cases diagnosed in 1994 to 2005 and requested pathology laboratories to prepare 1 representative block for HPV testing on those selected. Hematoxylin-eosin-stained sections preceding and following those used for extraction were reviewed to confirm representation. Human papillomavirus was detected using L1 consensus polymerase chain reaction (PCR) with PGMY9/11 primers and type-specific hybridization, with retesting of samples with negative and inadequate results with SPF10 primers. For IVC, the confirmatory hematoxylin-eosin slides were re-evaluated to determine histological type. Descriptive analyses were performed to examine distributions of HPV by histology and other factors.


RESULTS
Human papillomavirus was detected in 121/176 (68.8%) cases of IVC and 66/68 (97.1%) cases of VIN 3 (p < .0001). Patients with IVC and VIN 3 differed by median age (70 vs 55 y, p = .003). Human papillomavirus 16 was present in 48.6% of IVC cases and 80.9% of VIN 3 cases; other high-risk HPV was present in 19.2% of IVC cases and 13.2% of VIN 3 cases. Prevalence of HPV differed by squamous cell carcinoma histological subtype (p < .0001) as follows: keratinizing, 49.1% (n = 55); nonkeratinizing, 85.7% (n = 14), basaloid, 92.3% (n = 14), warty 78.2% (n = 55), and mixed warty/basaloid, 100% (n = 7).


CONCLUSIONS
Nearly all cases of VIN 3 and two thirds of IVC cases were positive for high-risk HPV. Prevalence of HPV ranged from 49.1% to 100% across squamous cell carcinoma histological subtypes. Given the high prevalence of HPV in IVC and VIN 3 cases, prophylactic vaccines have the potential to decrease the incidence of vulvar neoplasia.
Epidemic Intelligence Service, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. igc5@cdc.gov
Julia W
JW
Gargano
Edward J
EJ
Wilkinson
Elizabeth R
ER
Unger
Martin
M
Steinau
Meg
M
Watson
Youjie
Y
Huang
Glenn
G
Copeland
Wendy
W
Cozen
Marc T
MT
Goodman
Claudia
C
Hopenhayn
Charles F
CF
Lynch
Brenda Y
BY
Hernandez
Edward S
ES
Peters
Maria Sibug
MS
Saber
Christopher W
CW
Lyu
Lauren A
LA
Sands
Mona
M
Saraiya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000821:virology*; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D006651:Histocytochemistry; D006801:Humans; D008853:Microscopy; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology*; D016133:Polymerase Chain Reaction; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D015678:Viral Structural Proteins / Q000235:genetics; D014846:Vulvar Neoplasms / Q000821:virology*
D004279:DNA, Viral; D015678:Viral Structural Proteins