Which statement about vulvar cancer is true?

• A. It has peak incidence around age 30
• B. DES exposure is not related to vulvar cancer
• C. HPV infection with 16 or 18 is not linked
• D. HPV infection with 16 or 18 has been linked to vulvar cancer

Answer: (D)

High-risk human papillomavirus (HPV), especially types 16 and 18, is a known contributor to vulvar cancers. These viruses can integrate into vulvar squamous epithelium and drive malignant transformation through viral oncoproteins that disrupt tumor suppressor pathways. Because of this, HPV 16/18 infection has been linked to vulvar cancer, making that statement true.

Vulvar cancer typically occurs in older women, not with peak incidence around age 30, so that other idea is inaccurate. DES exposure is classically associated with other gynecologic cancers (notably vaginal and cervical cancers) and is not a primary driver of vulvar cancer, which is why the HPV link remains the most consistent and important association to recognize.