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#Grand Rounds

Lichen Sclerosus: How Common is it, and What is its Effect on Mortality?

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BACKGROUND AND PURPOSE:

  • Lichen sclerosus (LS) is known to be associated with an increased risk for vulvar squamous cell carcinoma
    • However, association with overall mortality is not well known
  • Halonen et al. (BJOG, 2020) assessed the incidence of LS in women and associated all-cause and cause-specific mortality

METHODS:

  • Population-based descriptive study
  • Participants
    • All Finnish women (1969 to 2012)
  • Study design
    • Data on women with LS were collected from the Finnish Hospital Discharge Register
    • Dates and causes of death for the population were retrieved from Statistics Finland and the Finnish Cancer Registry
    • Population statistics derived from Statistics Finland
  • Primary outcomes
    • Crude and age-adjusted incidence rates of LS
    • Standardized mortality ratios (SMRs)

RESULTS:

  • Women with LS: 7,790  
  • The age-adjusted incidence rate of LS increased from 2003 to 2010-2012
    • 2003: 14 per 100,000 women-years
    • 2010-2012: 22 per 100,000 women-years
    • Cumulative incidence of LS by 80 years: 1.6%
  • Age-specific incidence rate was highest in postmenopausal women, but was also elevated in girls 5-9 years old
    • Postmenopausal women: 24 to 53 per 100,000
    • Girls 5-9 years old: 7 per 100,000
  • All-cause mortality of women with LS was lower than in the general female population
    • SMR 0.84 (95% CI, 0.78 to 0.90)
  • This reduction in all-cause mortality was mostly due to decreased mortality from
    • Circulatory diseases: SMR 0.80 (95% CI 0.72 to 0.89)
    • Dementia and Alzheimer’s disease: SMR 0.75 (95% CI, 0.62 to 0.88)
  • Cancer mortality was similar to that of the general population
    • However, vulvar cancer mortality was increased: SMR 28.1 (95% CI, 19.3 to 39.4)

CONCLUSION:

  • LS is common and the risk of manifesting this disorder by age 80 was 1.6%
  • Risk for death due to circulatory diseases, and from dementia and Alzheimer’s disease, was decreased
  • All-cause mortality was lower in women with LS, but mortality from vulvar cancer was increased
  • Authors suggest various explanations for decreased all-cause mortality including
    • Healthier lifestyle in LS group (e.g. decreased chance of death from lung cancer and alcohol related diseases)
    •  Patients with LS may be seen more often in the healthcare system

Learn More – Primary Sources:

Incidence of lichen sclerosus and subsequent causes of death: a nationwide Finnish register study

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