Preventative Measures for Vulvar Cancer
Both avoiding HIV and not smoking are established preventative measures for vulvar cancer, making the correct answer C (both A and B).
Evidence-Based Risk Factors
The NCCN Clinical Practice Guidelines explicitly identify the following as known risk factors for vulvar cancer 1:
- Human papillomavirus (HPV) infection - the primary modifiable risk factor
- Cigarette smoking - directly increases risk
- Immunodeficiency - including HIV infection
- Inflammatory conditions affecting the vulva
- Increasing age
Specific Preventative Strategies
Avoiding HIV Infection
- HIV infection represents a significant risk factor for vulvar cancer through immunosuppression, which facilitates persistent HPV infection 1, 2
- HIV-positive individuals have a 30-fold higher risk of developing HPV-related cancers compared to the general population 1
- Immunodeficiency from HIV allows HPV persistence, which is the critical step in progression from infection to cancer 1
Smoking Cessation
- Cigarette smoking is an independent risk factor for vulvar cancer and acts as a cofactor that increases cancer risk among HPV-infected women 1, 3, 2
- Smoking increases the risk of persistent HPV infection and subsequent malignancy 3
- Current smoking intensity correlates with increased risk of HPV-related cancers 4
HPV Prevention (Additional Critical Strategy)
- HPV vaccination can prevent up to 90% of HPV-related cancers, including vulvar cancer 4
- HPV types 16 and 18 account for the majority of vulvar cancers, and current vaccines target these strains 1
- More than 80% of HPV-related cancers are caused by HPV16 and 18, increasing to over 90% when additional vaccine-covered types are included 4
Clinical Implications
The statement "there is no way to prevent it" (option D) is definitively incorrect. Multiple evidence-based prevention strategies exist, including:
- HPV vaccination (primary prevention) 1, 4
- Avoiding HIV infection (reduces immunosuppression risk) 1, 2
- Smoking cessation (eliminates cofactor for HPV persistence) 1, 3
- Early treatment of predisposing and preneoplastic lesions 5, 6, 7
Common pitfall: Clinicians may underestimate the preventable nature of vulvar cancer. With widespread HPV vaccination, one-half to two-thirds of vulvar and vaginal cancers may be prevented 2. Patient education regarding risk factor reduction is essential for primary prevention 2, 8.