Table 5.
Summary of cohort and case-control studies on all known and putative risk factors for vulvar cancer published between 1980 and 2020. Part 4.
| Risk Factor | First Author * [Ref.] | Year | Country | Design | Representativeness | Exposed | Cases | Controls | Age † |
|---|---|---|---|---|---|---|---|---|---|
| Smoking | Mabuchi [58] | 1985 | US | CC | Multicentre hospital-based case series | NA | 149 | 149 | 81% ≥50 |
| Smoking | Brinton [29] | 1990 | US | CC | Multicentre hospital-based case series | NA | 209 | 113 | Mean, 54 |
| Smoking | Daling [36] | 1992 | US | CC | 13-county, cancer-registry-based case series | NA | 295 | 902 | 69% <60 |
| Smoking | Daling [36] | 1992 | US | CC | 13-county, cancer-registry-based case series | NA | 295 | 902 | 69% <60 |
| Smoking | Daling [36] | 1992 | US | CC | 13-county, cancer-registry-based case series | NA | 295 | 902 | 69% <60 |
| Smoking | Daling [36] | 1992 | US | CC | 13-county, cancer-registry-based case series | NA | 295 | 902 | 69% <60 |
| Smoking | Daling [36] | 1992 | US | CC | 13-county, cancer-registry-based case series | NA | 295 | 902 | 69% <60 |
| Smoking | Daling [36] | 1992 | US | CC | 13-county, cancer-registry-based case series | NA | 295 | 902 | 69% <60 |
| Smoking | Parazzini [68] | 1995 | Italy | CC | Hospital-based case series | NA | 125 | 541 | Median, 63 |
| Smoking | Madeleine [59] | 1997 | US | CC | 3-county, cancer-registry-based case series | NA | 110 | 1403 | 52% ≥60 |
| Smoking | Madeleine [59] | 1997 | US | CC | 3-county, cancer-registry-based case series | NA | 110 | 1403 | 52% ≥60 |
| Smoking | Madeleine [59] | 1997 | US | CC | 3-county, cancer-registry-based case series | NA | 110 | 1403 | 52% ≥60 |
| Smoking | Madsen [61] | 2008 | Denmark | CC | Nationwide, cancer-registry-based series | NA | 116 | 518 | Median, 63 |
| Smoking | Coffey [33] | 2016 | UK | C | Cohort of attenders to a population-based MSP | 1,300,042 | 624 | NA | Range, 49–65 |
| Smoking | Brinton [30] | 2017 | US | CC | 8-state/area cohort of registered retired persons | 201,469 | 170 | NA | Mean, 61 |
| HIV | Silverberg [80] | 2009 | US | C | Healthcare delivery system cohort | NR | 12 | NA | ≥18 |
| HIV | Franzetti [44] | 2013 | Italy | C | Single-hospital-based cohort | 1542 | 5 | NA | Median, 42 |
| HIV | Hernández-Ramírez [50] | 2017 | US | C | Multistate, population-based cohort | NR | 151 | NA | NR |
| HIV | Mpunga [63] | 2018 | Rwanda | CC | Hospital-based case series | NA | 23 | 960 | NR |
| HIV | Ortiz [66] | 2018 | US | C | Multistate, population-based cohort | NR | 28 | NA | NR |
| HIV-AIDS | Hessol [51] | 2018 | US | C | Metropolitan, population-based cohort | 1338 | 14 | NA | ≥16 years |
| AIDS | Frisch [46] | 2000 | US | C | Multistate, population-based cohort | 51,760 | 12 | NA | Median, 33 |
| AIDS | Tanaka [83] | 2018 | Brazil | C | Metropolitan, population-based cohort | NR | 14 | NA | ≥13 |
| Dialysis | Fairley [43] | 1994 | Australia | C | 2-nationwide, population-based cohort | NR | 2 | NA | ≥15 |
| Dialysis/renal transplantation | Skov Dalgaard [82] | 2013 | Denmark | C | Nationwide, population-based cohort | 4610 | 15 | NA | ≥14 |
| Renal transplantation | Fairley [43] | 1994 | Australia | C | 2-nationwide, population-based cohort | NR | 24 | NA | ≥15 |
| Renal transplantation | Birkeland [23] | 1995 | Denmark | C | 4-nation, population-based cohort | 2369 | 11 | NA | NR |
| Renal transplantation | Vajdic [84] | 2006 | Australia | C | 2-nationwide, population-based cohort | 12,485 | 18 | NA | Mean, 50 |
| Renal transplantation | Villeneuve [86] | 2007 | Canada | C | Nationwide, population-based cohort | 4100 | 3 | NA | NR |
| Renal transplantation | Reinholdt [73] | 2020 | Denmark | C | Nationwide, population-based cohort | 1588 | 8 | NA | 63% ≥40 |
| S-O transplantation | Adami [21] | 2003 | Sweden | C | Nationwide, population-based cohort | 2339 | 9 | NA | NR |
| S-O transplantation | Engels [41] | 2011 | US | C | Multistate, population-based cohort | 68,705 | 58 | NA | NR |
| S-O transplantation | Madeleine [60] | 2013 | US | C | Nationwide, population-based cohort | 72,035 | 66 | NA | ≥18 |
| Paediatric S-O transplantation | Simard [81] | 2011 | Sweden | C | Nationwide, population-based cohort | NR | 3 | NA | <18 |
| Paediatric S-O transplantation | Yanik [88] | 2017 | US | C | Multistate, population-based cohort | 8210 | 2 | NA | <18 |
| Liver transplantation | Schrem [77] | 2013 | Germany | C | Single-hospital-based cohort | 940 | 5 | NA | NR |
| Risk factor | [Ref.] | Comparison | Disease | Measure | Result (95% CI) | Adjustment variables | |||
| Smoking | [58] | 10–20 cig./day vs. 0 | VC | OR | 2.46 (NR, p < 0.05) | NR | |||
| Smoking | [29] | Current smoker vs. never | VC | RR | 1.19 (0.6–2.2) | Age, no. of sexual partners, genital warts, previous abnormal Pap smear | |||
| Smoking | [36] | Current vs. never | VSCC | OR | 4.8 (3.3–6.8) | Age, geographic location, no. of sexual partners | |||
| Smoking | [36] | Former vs. never | VSCC | OR | 1.8 (1.2–2.8) | Age, geographic location, no. of sexual partners | |||
| Smoking | [36] | <20 cig./day (current) vs. 0 | VSCC | OR | 3.3 (2.0–5.3) | Age, geographic location, no. of sexual partners | |||
| Smoking | [36] | ≥40 cig./day (current) vs. 0 | VSCC | OR | 6.6 (3.5–12.3) | Age, geographic location, no. of sexual partners | |||
| Smoking | [36] | Age started <17 (current) vs. none | VSCC | OR | 6.8 (4.4–10.6) | Age, geographic location, no. of sexual partners | |||
| Smoking | [36] | Age started ≥20 (current) vs. none | VSCC | OR | 3.3 (2.0–5.5) | Age, geographic location, no. of sexual partners | |||
| Smoking | [68] | Ever vs. never | VC | OR | 1.1 (0.7–1.8) | Age, EDU, BMI | |||
| Smoking | [59] | Ever vs. never | VSCC | OR | 2.2 (1.3–3.7) | Age, EDU, BMI, HPV 16 seropositivity | |||
| Smoking | [59] | Former vs. never | VSCC | OR | 1.4 (0.7–2.8) | Age, EDU, BMI, HPV 16 seropositivity | |||
| Smoking | [59] | Current vs. never | VSCC | OR | 3.0 (1.7–5.3) | Age, EDU, BMI, HPV 16 seropositivity | |||
| Smoking | [61] | Current vs. never | VSCC | OR | 2.61 (1.53–4.46) | Age, EDU, alcohol, marital status, anogenital warts | |||
| Smoking | [33] | Current vs. never | VC | RR | 1.04 (0.87–1.26) | Age, DEPRI, alcohol, BMI, D, age at M, parity, OC, HYST, CIN3 | |||
| Smoking | [30] | Current vs. never | VC | HR | 1.86 (1.21–2.87) | Age, race, BMI, marital status, OC, menopausal hormone | |||
| HIV | [80] | Exposed vs. unexposed | V/VC | RR | 19.5 (9.2–41.1) | Age, year, race/ethnicity | |||
| HIV | [44] | Exposed vs. general population | VC | SIR | 69.2 (22.3–161.4) | Age | |||
| HIV | [50] | Exposed vs. general population | VC | SIR | 9.35 (7.91–10.96) | Age, year, race/ethnicity, registry | |||
| HIV | [63] | Cases vs. hospital controls | VC | OR | 17.8 (6.3–50.1) | Age, place of residence | |||
| HIV | [66] | Exposed vs. general Hispanic population | VC | SIR | 9.03 (6.00–13.1) | Age, year, registry | |||
| HIV-AIDS | [51] | Exposed vs. general population | VC | SIR | 13.3 (6.1–20.6) | Age, year, race | |||
| AIDS | [46] | Exposed vs. general population | V/VSCC | RR | 5.8 (3.0–10.2) | Age, race | |||
| AIDS | [83] | Exposed vs. general population | V/VC | SIR | 6.78 (4.02–11.45) | Age | |||
| Dialysis | [43] | Exposed vs. general population | VC | SIR | 4.2 (0.4–11.9) | Age | |||
| Dialysis/renal transplantation | [82] | Exposed vs. a population control cohort | V/VC | IRR | 5.81 (3.36–10.1) | Age, comorbidity | |||
| Renal transplantation | [43] | Exposed vs. general population | VC | SIR | 55.8 (35.8–83.0) | Age | |||
| Renal transplantation | [23] | Exposed vs. general population | V/VC | SIR | 31.0 (15.0–55.0) | Age, period | |||
| Renal transplantation | [84] | Exposed vs. general population | VC | SIR | 24.7 (S) | Age | |||
| Renal transplantation | [86] | Exposed vs. general population | VC | SIR | 5.5 (1.1–16.0) | Age, year | |||
| Renal transplantation | [73] | Exposed vs. a cohort of unaffected controls | VSCC | HR | 31.0 (13.3–72.0) | Age, EDU, income | |||
| S-O transplantation | [21] | Exposed vs. general population | VC | SIR | 26.2 (12.0–49.8) | Age, year | |||
| S-O transplantation | [41] | Exposed vs. general population | VC | SIR | 7.60 (5.77–9.83) | Age, year, race/ethnicity, registry | |||
| S-O transplantation | [60] | Exposed vs. general population | VC | SIR | 7.3 (5.6–9.2) | Age, year, race/ethnicity | |||
| Paediatric S-O transplantation | [81] | Exposed vs. general population | V/VC | SIR | 665.0 (137.1–1934.4) | Age, year | |||
| Paediatric S-O transplantation | [88] | Exposed vs. general population | VC | SIR | 17.4 (S) | Age, year, race/ethnicity | |||
| Liver transplantation. | [77] | Exposed vs. general population | VC | SIR | 23.80 (7.70–55.50) | Age | |||
AIDS = acquired immunodeficiency syndrome; BMI = body mass index; C = cohort; CC = case-control; CIN = cervical intraepithelial neoplasia; D = diabetes; DEPRI = deprivation; EDU = education; HIV = human immunodeficiency virus; HPV = human papillomavirus; HR = hazard ratio; HYST = hysterectomy; IRR = incidence rate ratio; M = menarche; MSP = mammography screening programme; NA = not applicable; NR = not reported; OC = oral contraceptive; OR = odds ratio; ref. = reference; RR = relative risk; S = significant; S-O = solid-organ; SIR = standardised incidence ratio; UK = United Kingdom; US = United States; V/VC = vulvar/vaginal cancer; V/VSCC = vulvar/vaginal squamous cell carcinoma; VC = vulvar cancer; vs. = versus; VSCC = vulvar squamous cell carcinoma. * In the case of international authorship, the country of the first author is indicated. † The best information made available in the article is indicated. In general, age refers to the age of cases at diagnosis in case-control studies and the age at entry into cohort studies. If possible, age is expressed in completed years.