Epidemiology of malignant degeneration of condylomata acuminata in Uganda.

A series of 73, 28 and 172 cases of condylomata acuminata and 133, 44 and 1,237 cases of carcinoma of vulva, vagina and penis is analysed. This material was derived from a country-wide biopsy service in Uganda between the years 1964-1975. Condylomata acuminata occurred mainly in young and elderly persons and thus preceded the cases of carcinoma by decades and years in age-distribution, respectively. Geographical correlations with cancer observed in the 18 districts of the country were high for all condylomata acuminata combined and for cases occurring in young and elderly persons. 12 cases were observed in which histological features suggestive of transition to malignancy had been noted in the biopsy report, and 7 out of 10 such cases with known age were seen among the elderly. A high rate of malignant degeneration was observed in the age-group 40 years and over, namely 5 or possibly 6 cases among 36 condylomata acuminata whereas in the lower age-groups none or possibly one example was found out of 210 cases. Another feature varying with age of the patient was the time-interval between the biopsy diagnosis of condylomata acuminata and cancer. The values amounted to months and several years in the higher age-groups in contrast to 8 years observed in the one case occurring in young age. Moreover, in a review of 35 cases found in the literature duration of malignant degeneration differed between decades in young and years and months in high age except in a medium age-range of 30-45 years in which observations varied widely. These findings adduce indirect, and, in the case of the observed rate of malignant degeneration, perhaps tentative direct evidence for the long postulated association between cancer, condylomata acuminata and thus possibly an underlying viral agent. Condylomata acuminata could be precancerous lesions showing a low risk and long time-interval to malignancy in young and a high risk and short time-interval in later age.