Rising U.S. trends in HPV-positive and HPV-negative vulvar cancer in older adults, 2000-2020.

Objective: To evaluate rising vulvar cancer incidence in the United States, particularly in individuals aged ≥55, and assess whether increases are driven by HPV-positive or HPV-negative disease. Methods: We analyzed vulvar cancer incidence trends from 2000 to 2020 using data from the National Cancer Institute's SEER program, covering 47.9 % of the U.S. population. Cases were classified as HPV-positive or HPV-negative, and age groups were stratified as <55, 55-64, and 65 + . Linear regression analyses assessed trends and racial/ethnic disparities, with statistical significance set at p < 0.05. Results: Vulvar cancer incidence increased significantly among individuals aged ≥55 from 2000 to 2020 (p < 0.01), with both HPV-positive and HPV-negative cases contributing to this rise. The sharpest increase in HPV-positive cancers occurred in the 55-64 age group, with a 53 % increase, while HPV-negative cancers in this same group rose by 23 %. Individuals aged ≥65 also experienced increases in both subtypes, though to a lesser extent. In contrast, individuals under 55 slightly declined in HPV-positive (1.5 %) and HPV-negative (5 %) cases over the same period. Conclusion: The rising incidence of both HPV-positive and HPV-negative vulvar cancer among individuals aged ≥55 reflects shifting trends in disease burden. These findings align with prior SEER analyses showing an in situ diagnoses decline and a rise in invasive cases. In the absence of standardized screening guidelines for vulvar cancer, our results underscore the importance of continued surveillance and risk-based gynecologic evaluation strategies in older populations.