Here's an article on VaIN and VIN we ran in HPV News. Hopefully this will give some more insight.Interview with Dr. Mark Einstein
Reprinted from the July 2006 HPV News. Copyright, 2007 - American Social Health Association. All Rights Reserved. To subscribe go to http://www.ashastd.org
The link between Ã¢â‚¬Å“high-riskÃ¢â‚¬Â HPV types and cervical cancer has understandably been the focus of recent media attention due to the approval in June by the FDA of the first HPV/cervical cancer vaccine. Diseases related to HPV arenÃ¢â‚¬â„¢t limited to the cervix, of course, and the News Desk section of this issue of HPV News has an article on the promise HPV vaccines have in preventing other diseases related to HPV, such as precancers of the vulva and vagina (known as vulvar intraepithelial neoplasia and vaginal intraepithelial neoplasia, or VIN and VAIN, respectively).
To learn more about how these diseases are diagnosed and managed, HPV News spoke with Mark Einstein, MD, assistant professor, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and WomenÃ¢â‚¬â„¢s Health at Albert Einstein College of Medicine and Montefiore Medical Center in New York. In addition to caring for patients, Dr. Einstein is a researcher who investigates potential therapies for gynecologic cancers.HPV News: How common are VIN and VAIN?
Mark Einstein: The best estimates are about 1 to 2 cases per 100,000 for VIN and even less for VAIN. There seem to be some differences based on geography, what kind of patient population, etc. [editorÃ¢â‚¬â„¢s note: the American Cancer Society estimates there are approximately 9,700 cases of cervical cancer annually in the U.S., and about 3,700 deaths]Speaking of patient populations is there a specific demographic in which VIN or VAIN is more common?
LetÃ¢â‚¬â„¢s split it up because there is some difference between the two. Certainly, Ã¢â‚¬Å“high-riskÃ¢â‚¬Â HPV status is highly correlated with VIN and the disease is typically more common in older women; mean age is reported around 52. There seems to be an increased risk in patients with lichens sclerosis [LS, a condition where affected skin develops white spots that become shiny and smooth], and this could be because LS often Ã¢â‚¬Å“hidesÃ¢â‚¬Â the VIN, as these patients have very thick skin in this area.
With VAIN, itÃ¢â‚¬â„¢s also found in older women and the average age seems to be somewhat higher than that of VIN. These patients also have a lot of the similar characteristics as patients with VIN; while they donÃ¢â‚¬â„¢t get LS there is a high correlation with previous HPV infection. There also seems to be an increased risk of both VIN and VAIN related to smoking.Is it safe to say VIN and VAIN are usually related to Ã¢â‚¬Å“high riskÃ¢â‚¬Â HPV?
Absolutely. I think the relationship between HPV and VIN/VAIN is less than that of HPV and cervical precancers, but there certainly is a high relationship here - IÃ¢â‚¬â„¢d say 60-70% of VIN/VAIN have Ã¢â‚¬Å“high riskÃ¢â‚¬Â HPV status.
How are VIN and VAIN diagnosed clinically?
WeÃ¢â‚¬â„¢ll perform a vaginoscopy [using a special microscope called a colposcope] to look thoroughly at the vagina and vulva and then perform a biopsy on any lesions that are detected.
If there are no obvious lesions we often perform random biopsies; for VAIN, as an example, we most often perform those biopsies in the upper third of the vagina, which is the most common place where these types of lesions form.