POSTMENOPAUSAL BARTHOLIN GLAND ENLARGEMENT - A HOSPITAL-BASED CANCER RISK ASSESSMENT

Objective: To assess the risk of Bartholin gland carcinoma in postmeno pausal women. Methods: A referral patient population from a tertiary c are cancer center and a hospital-based regional tumor registry was use d in a case-control and retrospective cohort study. We searched for da ta on any discharge diagnosis or procedures involving the Bartholin gl and, including excision, cystectomy, or marsupialization, and patholog y reports confirming cancer diagnoses from a hospital-based regional t umor registry and a tertiary hospital's medical records department and operating room log. Results: A total of 284 patients were identified, 161 patients from the hospital-based tumor registry and 123 from the tertiary hospital data bases. Pathology reports from 104 of the 161 pa tients with vulvar cancer were available and revealed two primary aden ocarcinomas in postmenopausal women, one squamous cell carcinoma of th e Bartholin gland in a postmenopausal woman, and two squamous cell car cinomas of the Bartholin gland in premenopausal patients over a 24-yea r period. Based on local New York State Department of Health census da ta, the incidence of Bartholin gland carcinoma was 0.023 per 100,000 w oman-years in premenopausal women and 0.114 per 100,000 woman-years in postmenopausal women (incidence rate ratio 5.01, 95% confidence inter val [CI] 0.67-25.1). The overall incidence rate of squamous cell vulva r carcinoma was 0.42 per 100,000 woman-years in premenopausal and 4.72 per 100,000 woman-years in postmenopausal women (odds ratio [OR] 11.5 5, 95% CI 7.82-17.14). The ratio of Bartholin gland cancer to other vu lvar cancers was two per 37 in premenopausal women versus three per 12 4 in postmenopausal women (OR 2.3, 95% CI 0.39-17.9). Of thirteen post menopausal patients (mean age 65.4 years) with Bartholin gland enlarge ment admitted to the tertiary care center, only four (30.8%) had excis ions, whereas the remainder (69.2%) had drainage or marsupialization. None of the patients treated with drainage or marsupialization were li sted subsequently in the tumor registry as developing Bartholin gland cancer during a median surveillance of 10.3 years (range 1.7-14.4). Co nclusion: Bartholin gland cancer is exceedingly rare in all women, inc luding postmenopausal women. We were unable to find evidence that woul d justify excision as the initial treatment of a Bartholin gland enlar gement in postmenopausal women. Drainage and selective biopsy may be s ufficient as initial management.