Risk factors for vaginal cancer

A risk factor is anything that increases the chance of developing a disease. Several factors have been linked to vaginal cancer, but having one or more risk factors does not mean you will develop cancer.

Persistent infection with certain types of human papillomavirus (HPV) is one of the most important vaginal cancer risk factors. Age, smoking, a history of vaginal or cervical precancer, previous cervical cancer, and a weakened immune system can also increase risk.

Some people who develop vaginal cancer have no known risk factors. Researchers continue to study why vaginal cancer develops and why only a small number of people with known risk factors eventually develop the disease.

What are the main vaginal cancer risk factors?

The most important known vaginal cancer risk factors include:

• Persistent infection with high-risk HPV

• Older age

• Vaginal intraepithelial neoplasia (VaIN)

• A history of cervical precancer or cervical cancer

• Smoking

• A weakened immune system

• Exposure before birth to diethylstilbestrol (DES)

These factors do not all carry the same level of risk. Some can be changed or prevented, while others, such as age or previous DES exposure, cannot.

How does human papillomavirus increase vaginal cancer risk?

Human papillomavirus (HPV) is a very common group of viruses. Most HPV infections go away on their own without causing health problems. However, persistent infection with certain high-risk types of HPV can cause abnormal changes in cells.

Over time, these changes can potentially progress from precancer to invasive cancer. HPV is associated with vaginal cancer as well as several other cancers, including cervical cancer, vulvar cancer, anal cancer, and penile cancer.

Having HPV does not mean you will develop cancer. Most people infected with HPV never develop an HPV-related cancer.

Can the HPV vaccine lower vaginal cancer risk?

The HPV vaccine protects against HPV types responsible for many HPV-related cancers and precancers. Vaccination is an important form of prevention because it can prevent new infections with high-risk HPV types.

The vaccine works best when given before exposure to HPV, but vaccination may still be recommended for some people later in life depending on age and individual circumstances.

The HPV vaccine does not treat an HPV infection that is already present or reverse existing precancerous changes. However, preventing high-risk HPV infections can reduce the chance of developing HPV-related cancers in the future.

Does vaginal precancer increase the risk of vaginal cancer?

Vaginal intraepithelial neoplasia, or VaIN, is a precancerous condition involving abnormal cells in the vaginal lining.

VaIN is not invasive cancer, and many cases will never become cancer. However, higher-grade VaIN contains more abnormal cells and has a greater potential to develop cancerous changes over time.

People diagnosed with VaIN may need treatment or continued monitoring depending on the severity of the abnormal changes and their individual risk factors.

How do cervical cancer and changes in the cervix affect risk?

A history of precancerous changes in the cervix, sometimes called cervical dysplasia, is associated with an increased risk of vaginal cancer. Previous cervical cancer also increases risk.

One reason is that both diseases are strongly associated with high-risk HPV. Someone who develops abnormal cervical cells because of persistent HPV infection may also have HPV-related changes elsewhere in the genital tract.

This connection is one reason healthcare providers consider a person's history of cervical precancer and cervical cancer when assessing vaginal cancer risk.

Does having a hysterectomy eliminate vaginal cancer risk?

No. A hysterectomy removes the uterus and, depending on the type of surgery, may also remove the cervix. It does not remove the vagina.

Vaginal cancer can therefore still develop after a hysterectomy. Follow-up recommendations after hysterectomy depend on why the surgery was performed and whether the patient has a history of cervical cancer, cervical precancer, VaIN, or other relevant conditions.

An HPV test or other follow-up testing may be recommended for certain higher-risk patients, but there is no routine vaginal cancer screening program for everyone who has undergone hysterectomy.

Does age increase the risk of vaginal cancer?

Age is an important vaginal cancer risk factor. Vaginal cancer occurs most often in older adults, particularly people over age 60.

Cancer can develop after abnormal cells accumulate genetic changes over many years. Long-term HPV infection may also contribute to the development of vaginal cancer later in life.

Younger people can still develop vaginal cancer, so persistent or concerning symptoms should be evaluated regardless of age.

Does smoking increase vaginal cancer risk?

Smoking is another modifiable risk factor for vaginal cancer.

Tobacco smoke contains cancer-causing chemicals that can damage cells throughout the body. Smoking may also interfere with the immune system's ability to clear HPV infections, allowing an infection to persist longer.

Quitting smoking can reduce the risk of many cancers and provides health benefits regardless of how long someone has smoked.

Can a weakened immune system increase vaginal cancer risk?

A weakened immune system can make it more difficult for the body to clear HPV infections.

People living with HIV or taking medications that suppress the immune system may therefore have an increased risk of persistent HPV infection and HPV-related precancers and cancers.

Your healthcare provider can help determine whether your medical history or medications affect your individual risk and whether additional follow-up is appropriate.

Does DES exposure increase vaginal cancer risk?

Diethylstilbestrol, or DES, is a medication that was prescribed to some pregnant women between the 1940s and early 1970s.

People exposed to DES before birth have an increased risk of developing clear cell adenocarcinoma of the vagina or cervix. This type of vaginal cancer is rare, even among people who were exposed to DES.

If you know or suspect that you were exposed to DES before birth, tell your healthcare provider so they can determine what follow-up is appropriate.

Can vaginal irritation increase the risk of vaginal cancer?

Having occasional vaginal irritation does not mean you are developing vaginal cancer. Irritation, itching, burning, and discomfort are common and can result from infections, hormonal changes, skin conditions, or other noncancerous causes.

Research has examined whether chronic irritation or inflammation may be associated with cancer development, but HPV and established precancerous changes are much more important recognized risk factors.

Persistent vaginal irritation or other unexplained symptoms should still be evaluated so your healthcare provider can identify the cause.

What other risk factors are being studied?

Because vaginal cancer is rare, researchers have less information about its causes than they do for more common gynecologic cancers.

Researchers continue to investigate other risk factors and how HPV, immune function, smoking, age, previous cancers, and genetic or environmental factors may interact.

Studies published in fields such as gynecology and obstetrics also help researchers better understand the development and management of rare gynecologic cancers.

Can you lower your risk of vaginal cancer?

You cannot change certain risk factors, such as your age or exposure to DES before birth. However, there are steps that may reduce your risk of HPV-related vaginal cancer.

HPV vaccination and avoiding tobacco are two of the most important actions. Following recommended cervical cancer screening guidelines can also identify abnormal cervical cells that need additional evaluation.

There is no routine screening test specifically recommended for vaginal cancer in average-risk people. An HPV test is primarily used as part of cervical cancer screening and should not be considered a general vaginal cancer screening test.

When should you talk to your doctor about vaginal cancer risks and symptoms?

Talk with your healthcare provider if you are concerned about your vaginal cancer risk, particularly if you have a history of VaIN, cervical dysplasia, cervical cancer, persistent high-risk HPV, DES exposure, or a weakened immune system.

You should also make an appointment if you experience unexplained vaginal bleeding, bleeding after sex, bleeding after menopause, persistent vaginal discharge, a vaginal lump, pelvic pain, or other persistent symptoms.

Your gynecologist or gynecologic oncologist can help assess your individual risk. People with complex histories may also receive care through a gynecologic cancer specialist or comprehensive cancer center, particularly if abnormalities involving the vagina, cervix, vulva, or other structures in the pelvis require further evaluation.