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Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Christer Borgfeldt, Linköping University,
- Second opponent: Associate Professor Tine Henrichsen-Schnack, University of Southern Denmark, Denmark
- Third member and chair of the evaluation committee: Associate Professor Ane Gerda Zahl Eriksson, University of Oslo
Chair of the Defence
Pro-Dean of Studies Magnus Løberg, University of Oslo
Principal Supervisor
Professor II Ingvild Vistad, University of Oslo
Summary
Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with two subtypes: HPV-independent and HPV-associated. The latter affects younger women and accounts for 25–40% of cases. International studies have shown rising VSCC incidence rates, especially among younger women, possibly linked to an increasing proportion of HPV-associated tumors. HPV status may also influence prognosis and given the impact of treatment on quality of life, better risk stratification is essential to avoid overtreatment and long-term morbidity.
This thesis explored: 1) incidence and age trends in Norway over recent decades, 2) changes in HPV-associated VSCC and its impact on survival, and 3) survivorship challenges more than five years post-treatment.
Using data from the Cancer Registry of Norway, we found that VSCC incidence rates rose 2.5-fold from 1961 to 2010, with the steepest increase among women under 60. HPV analysis of tumor samples from 1970–75 and 2000–05 showed a significant rise in HPV-positive tumors (23% to 35%). The predominant genotypes detected were HPV 16, 33, and 18, with similar distributions in both periods. Finally, we found that one-third of long-term survivors reported clinically significant issues, including impaired physical, emotional, cognitive, and social functioning, pain, and fatigue. Compared to normative samples, survivors had more vulvar and groin symptoms, were less likely to be sexually active and reported more sexual dysfunction.
In conclusion, the incidence of VSCC in Norway has increased, particularly among younger women, with a growing proportion of HPV-associated cases. Survivors face substantial long-term challenges, underscoring the need for improved risk stratification and survivorship care.
Additional information
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