An epidemic of vulvar cancer in young women: investigating the role of Human Papillomavirus and genetic susceptibility

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Vulvar cancer is a rare disease; in 1993-1997 the age-adjusted incidence rate in Australia was 1.4 per 100,000 women (average 207 cases per year), similar to the incidence in most other countries. An epidemic of cases of vulvar cancer has been identified in younger Indigenous women living in remote communities in the Northern Territory (NT). Vulvar cancer is over fifty times more common in women aged less than 50 years in these communities than in the total Australian population. Women in these communities also experience higher rates of high-grade Vulvar Intraepithelial Neoplasia (a pre-cursor to vulvar cancer), than elsewhere in the NT. Vulvar cancer is usually much more common in older women than younger women. In young women vulvar cancer and VIN are thought to be caused by infection with cancer causing strains of human papillomavirus (HPV), particularly the strain known as HPV16. In older women, vulvar cancer is not caused by HPV. In the remote communities in the NT, vulvar cancer is occurring almost entirely in young women, the amount of cancer occurring in older women in these communities is similar to the amount expected in the total Australian population. This project will investigate the cause of this epidemic of vulvar cancer and high-grade VIN. It will investigate whether HPV16 is more prevalent in these communities than elsewhere in Australia; whether there is a variant strain of HPV16 in these communites that is more virulent at causing cancer, and whether the disease occurs more commonly in families, which would mean that women in these communities inherit an increased susceptibility to vulvar cancer and VIN. This project will help to increase our understanding of vulvar cancer and VIN, help to control this epidemic, and inform whether the new HPV vaccines may be effective in preventing vulvar cancer in these communities.