Vulvo-vaginal cancer trends during the pandemic.

Abstract

e17609
Background: During the COVID-19 pandemic, many patients in the United States experienced access-to-care issues. We hypothesized this may have disrupted recent trends in incidence for diseases such as vulvar and vaginal carcinoma often identified on physical exam and biopsy. In this study, we aimed to evaluate the impact of the COVID-19 pandemic on vulvar and vaginal carcinoma incidence based on age and race. Methods: Data on cancer incidence were obtained from the United States Cancer Statistics program. We employed SEER*Stat 8.4.1.2 and Joinpoint regression program 5.0.2. We compared actual vulvar and vaginal squamous cell carcinoma incidence rates in the year 2020 to estimated rates based on trends from the years 2001-2019. Results: From 2001-2020, 69,114 cases of vulvar carcinoma and 15,419 cases of vaginal carcinoma were identified. In 2019, the incidence rate was 2.14 and 0.44 per 100,000 people for vulvar and vaginal cancer, respectively. Using data from 2001-2019, there was a 1.19% increase per year in vulvar cases per year (p<0.001), while vaginal cases remained stable (average annual percent change -0.24%, p=0.179). Based on the trend noted in vulvar SCC, we expected incidence of vulvar SCC to be 2.19 per 100,000 patients in 2020, however, the reported 2020 incidence was 1.99 per 100,000. Based on these calculations, there were 9.03% fewer vulvar cases (n=246) in 2020 than expected. Assuming vaginal incidence rates remained stable, there were 9.34% fewer vaginal cases (n=70) in 2020 than expected. Based on race, non-Hispanic Asian and Pacific Islander patients experienced the largest proportional difference in actual vs expected cases of vulvar cancer, with the actual 2020 case numbers being 38% fewer (n=23) than expected based on trends. For vaginal cancer, the largest proportional difference in actual vs expected cases was among Hispanic patients, with the actual 2020 case numbers being 24% fewer than expected (n=32). Conclusions: During the 2020 COVID-19 pandemic, the incidence of vulvo-vaginal cancers was less than expected given the established trends, particularly in NHAPI and Hispanic patients. Further research is warranted to better determine if the above-described gaps were from delayed diagnosis due to access of care or other causes.