Background: The epidemiology of vulvar cancer is rapidly changing due to changing prevalence of human papilloma virus infection, human immunodeficiency virus infection and other risk factors in South Africa and globally. We evaluated the vulvar cancer mortality trends in South Africa from 1999 to 2018.

Methods: Data collected by Statistics South Africa were utilised to conduct age-period-cohort analysis and Joinpoint regression modelling of trends in the age-standardised mortality rate (ASMR) of vulvar cancer in South Africa. Ethnic trends were also calculated and compared.

Results: From 1999 to 2018, 1,922 vulvar cancer mortalities were reported, with a decline in mean age from 57.2 years in 1999 to 50.8 years in 2018. The ASMR increased by 5.4% per annum from 0.23 deaths per 100,000 women in 1999 to 0.76 deaths per 100,000 women in 2018, p < 0.001. In 2018, the Indian/Asian (0.75 per 100,000 women), Blacks (0.74 per 100,000 women) and Mixed race (0.71 per 100,000 women) had relatively high ethnic-specific ASMR of vulvar cancer as compared to the ASMR among Whites (0.36 per 100,000 women). From 1999 to 2018, Blacks average annual percent change (AAPC: 7.8%, p < 0.001) and Whites (AAPC: 3.8, p < 0.001) had statistically significant annual increases in ASMR of vulvar cancer. However, Mixed race (AAPC: 2.1%, p 0.2) and Indian/Asians had non-significant increases in annual ASMR of vulvar cancer (AAPC: 1.9, p 0.3). There were significant age, period and cohort effects on vulvar cancer mortality trends in South Africa and among the Black ethnic group.

Conclusion: Our study showed significant increase in vulvar cancer mortality trends with a decline in average age at mortality in South Africa. All ethnic groups had increased vulvar mortality rates to varying degrees.