Study Reveals Elevated Vulvar Cancer Risks Linked to Lichen Sclerosus in Older Women

A recent study published in the Journal of the American Medical Association Dermatology has unveiled critical insights regarding the prevalence and risks associated with vulvar lichen sclerosus (VLS) among older women. The analysis, led by Dr. Surya A. Veerabagu of The University of New Mexico, examined data from over 2.5 million female Medicare beneficiaries aged 65 and older from October 2015 to December 2021. This research highlights a concerning correlation between VLS and the incidence of vulvar squamous cell carcinoma (VcSCC) or carcinoma in situ (VcSCCis).

### Prevalence and Risk Assessment According to the study, VLS was found in 0.7% of the population analyzed, translating to approximately 17,987 cases. Notably, patients with VLS exhibited an 11-fold increased risk of developing VcSCC or VcSCCis compared to those without the condition. The mean age of the participants was 73 years, and the demographic breakdown indicated that 93.5% of the VLS patients were white, which raises questions about the potential underdiagnosis in minority populations.

Dr. Kelly H. Tyler, from the Department of Dermatology at The Ohio State University Wexner Medical Center, emphasized the need for a multidisciplinary approach in managing patients with VLS, noting that dermatologists play a crucial role in addressing this underserved demographic. In her editorial accompanying the study, Dr. Tyler highlighted that a significant proportion (72.6%) of VLS patients received appropriate treatment, predominantly topical corticosteroids or calcineurin inhibitors, which are known to mitigate cancer risk.

### Methodological Insights The study’s methodology involved analyzing Medicare data and employing disease and treatment codes. However, it acknowledged limitations in generalizability, primarily due to its focus on older women and potential inaccuracies in coding. The findings suggest a prevalence of VLS that is markedly higher than the 0.05% observed in younger women, which may be attributed to both the sensitive nature of the condition and challenges in healthcare access for older populations.

### Treatment Patterns and Implications Despite the alarming prevalence of VLS, only a small fraction of the diagnosed patients (1.2%, or 162 individuals) went on to develop VcSCC or VcSCCis. Among those diagnosed with cancer, a significant majority (80.9%) underwent nontissue-sparing treatments, indicating a potential gap in the management strategies employed by healthcare providers.

### Future Directions The findings from this study signal a pressing need for increased awareness and proactive management of VLS among older women. Experts urge for improved diagnostic practices and treatment options tailored to this demographic to mitigate the elevated risk of vulvar cancer. As more research emerges, it will be essential to explore the underlying causes of the heightened risk and to develop targeted intervention strategies.

In conclusion, while the study presents a clearer understanding of the relationship between VLS and vulvar cancer risks, further research is necessary to establish comprehensive care pathways for affected individuals. The implications of these findings extend beyond just individual health, potentially influencing public health policies and healthcare practices aimed at improving outcomes for older women suffering from this condition.