BSV07 Vulval intraepithelial neoplasia: a report of national epidemiology in England, 2013–2022

Abstract

Vulval intraepithelial neoplasia (VIN) is a premalignant lesion of the vulval squamous epithelium, commonly associated with high-risk human papillomavirus (HPV) infection. National epidemiological data are limited. This national retrospective cohort study reports the statistics of VIN epidemiology in England from 2013 to 2022. Data were obtained from the National Disease Registration Service ‘Get Data Out – Skin’ dataset. Cases of VIN were identified by selecting data grouped as ‘external genital SCC in situ’ in female patients. Age- and gender-standardized rates (EASRs) were calculated using the European Standard Population 2013, and crude incidence rates were reported per 100 000 person-years with 95% confidence intervals (CIs). Joinpoint regression analysis was performed using SEER (version 5.4.0), to calculate the annual percentage change. Incidence rate ratios (IRRs) were calculated to assess the impact of COVID-19 between 2019 and 2020. Survival estimates were for the 2013–2015 cohort. Between 2013 and 2022, 7765 cases of VIN were recorded, with a median of 769 cases annually (interquartile range 690–882). The most affected age group was 50–54 years (n = 1026). By self-reported ethnicity, 83.0%, 2.5%, 0.9%, < 0.1% and 13.5% of cases occurred in those of White, Black, Asian, Chinese and mixed/other/unknown ethnicities, respectively. There was no significant difference in incidence between deprivation quintiles 1 and 5 (χ2 = 1.17; P = 0.28). The EASR was 2.81 (95% CI 2.75–2.88), with a crude incidence rate of 2.71. The 2013–2022 APC was +2.77% (95% CI 1.49–4.12). Incidence rates declined between 2019 and 2020 (IRR 0.86, 95% CI 0.78–0.95), likely reflecting reduced diagnostic activity during COVID-19. Net survival was 95% (95% CI 93.5–96.4) at 5 years. This study provides the largest recent national data on VIN in England, demonstrating a rising incidence and high net survival. These findings provide a benchmark for monitoring future trends, including the impact of HPV vaccination.