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Cervical Dysplasia

Introduction

What should I know about Cervical Dysplasia?

Cervical dysplasia may be defined as abnormal changes in the cells of the cervix often associated with human papillomavirus infections. (1) You might also hear it referred to as cervical intraepithelial neoplasia (CIN), or if you have recently had a pap smear, as squamous intraepithelial lesion (SIL). Cervical dysplasia is classified into three categories; mild, moderate, and severe, depending on the depth of the changes in the epithelial cells.

It is always good to know what the risk factors are for conditions like cervical dysplasia and there are various risk factors associated with this condition. Studies have indicated that the risk of cervical dysplasia is higher for women with multiple partners, women who’s sexual partners are more promiscuous, and women whose first sexual intercourse was at an early age. (2) Other studies have linked the number of sexual partners as a strong risk factor and it has been reported that there may be a link between cigarette smoking and CIN and invasive cervical cancer. (3) In fact, some of these studies have shown a two-fold increased risk for the development of abnormal cells in the cervix among smokers and a relationship with the duration and intensity of smoking. (4)

We have all been reading about how certain nutritional factors may be involved in certain cancers. Reports indicate that nutritional factors have been implicated in 60% of cancers in women and 40% of cancers in men. (5) This leads us to believe that some nutrients may help to protect the cervix from developing abnormal cells. Vitamin A, carotenoids, vitamin C, vitamin E, and folic acid have been reported to have this protective effect. (6) However, to date it has been difficult to compare these studies because there are so many variations in the methods of measuring the nutrients as well as in how the participants in the studies were selected.

In recent years, there has been a strong link between the risk of cervical dysplasia and some of the various types of human papilloma viruses. More than 90% of cervical cancers contain DNA of the higher risk HPV viruses and that DNA has been found to be present in the early stage lesions of cervical cancer. (7) , (8)

Statistic

National Cervical Cancer Coalition (NCCC), 2005.

  • An estimated 5 percent of women in developing countries have been screened for cervical dysplasia in the past 5 years compared with some 40 to 50 percent of women in developed countries.
  • Worldwide, there are at least 350,000 new cases of cervical cancer per year, of which 80 percent occur in developing countries.
  • In many Western countries, invasive cervical cancer incidence and mortality has been reduced by as much as 90 percent through screening programs.

Second Report of National Cancer Registry in Malaysia, 2003.

  • Cancer of the cervix is the second most common cancer among females in Malaysia after breast cancer.
  • It constituted 12.9% of total female cancers. There were a total of 1,557 cases of cervical cancer, with age standardized rate (ASR) of 19.7 per 100,000 population.

American Medical Association, 1999.

    Sixty to 80 percent of CIN 1 dysplasias typically resolve on their own, and only about 1 percent progress to invasive cervical cancer. On the other hand, less than one third of CIN 3 dysplasias disappear spontaneously, and about 12 percent eventually progress to cervical cancer. Approximately 600,000 American women are diagnosed with cervical dysplasia annually, compared with only 13,000 new cases of invasive cervical cancer. Although the highest rates of cervical dysplasia are among women of African American, Native American, and Hispanic background, this may not be due to an increased genetic (inherited) risk for the condition. Instead, it may reflect social and economic factors, including limited access to good medical care.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Often there are no symptoms associated with cervical dysplasia, which is one reason that regular check-ups are advised. Occasionally there is association with genital warts in the vulva or vagina, or other existing sexually transmitted diseases in the lower reproductive tract such as chlamydia or gonorrhea.

General

  • Frequently there are no symptoms
  • Occasionally there is association with sexually transmitted diseases

Treatment Options

Conventional

In cases of mild dysplasia, treatment may be done on an outpatient basis, or in the physician’s office. If untreated, another Pap test should be performed in four to six months. If the smear still shows mild dysplasia, an examination using a device called a colposcope may be done. This device allows the examiner to more clearly see the area of the cervix that is questionable.

For moderate dysplasia, several different techniques may be used to obtain and examine the cervical cells. These include freezing, the use of lasers, cold knife, electro surgical loop, and excisional cone therapy. If the dysplasia is severe, then a cone biopsy is performed and cells are examined for evidence of cervical cancer.

Advice for lowering risk of cervical dysplasia includes having just one sexual partner, and smoking cessation. Eating a very healthy diet, which increases consumption of folic acid, is also often recommended.

Nutritional Suplementation


Folic Acid

When a person becomes deficient in folic acid, there is a tendency for abnormal cells to develop, especially in areas of the body that have a high rate of cellular turnover, such as the uterine lining in women who are regularly menstruating. There are several studies that report an association between low levels of folic acid and the development of cervical dysplasia. (9) , (10) , (11) In fact, one study concluded that low folic acid levels cause a 5-fold increase in the likelihood that a woman will develop cervical dysplasia. (12)

Birth control pills are known to deplete folic acid, which may contribute to the development of cervical dysplasia in women using this form of contraception. While some studies show that there may be a way to reverse this condition using folic acid supplements, other studies are not conclusive. (13) , (14)


Vitamin A, Beta-Carotene

One study reported that women with lower levels of vitamin A or beta-carotene had a 3-fold greater risk for developing severe cervical dysplasia. (15) Also, in women already diagnosed with cervical dysplasia, the rate of progression to invasive cervical cancer was 4.5 times higher in women with lower vitamin A levels than those with higher levels. These results suggest that low serum retinol levels also increase the risk of cervical dysplasia developing into cervical cancer. Although vitamin A and beta-carotene seem to be important in the prevention of cervical dysplasia, once again, there is not enough evidence to support that these nutrients would be useful in slowing the disease once is has been established. (16)


Vitamin C

Studies have reported that women who don’t get enough vitamin C were found to have substantially greater risks of developing cervical dysplasia. (17) , (18) This again seems to be a method related to prevention rather than to treatment. (19)


Vitamin E

There seems to be a relationship between the levels of vitamin E in the body and the severity of cervical dysplasia indicating a need for supplementing with this nutrient. (20)

Herbal Suplementation


Chasteberry

Chasteberry (or also known as vitex) has been recommended for use in mild to moderate complaints, especially in endometriosis, menopause, and PMS symptoms. Because of its activity in stimulating various hormonal actions, vitex has been recommended for a variety of female complaints, such as cervical dysplasia, dysmenorrhea, amenorrhea, menopausal symptoms, endometriosis, and hyperprolactinemia. (21) , (22) , (23) Vitex should not be used with other hormone replacement products unless recommended by your healthcare professional.


Bromelain

Bromelain is used clinically in conditions such as soft tissue inflammation and arthritis, dyspepsia, cervical dysplasia and dysmenorrhea, as well as a digestive aid. (24)

References

  1. Shiu AT. Cervical dysplasia. In: Dambro MR ed. Griffith’s 5-minute Clinical Consult. Philadelphia: Lippincott, Wlliams, & Wilkins; 1999:103.
  2. Munoz N. Bosch FX: Epidemiology of cervical cancer. IARC Sci Publ. 1989;94:9.
  3. Wilkenstein W. Smoking and cervical cancer--current status: A review. Am J Epidemiol. 1990;131:945.
  4. View Abstract: Brinton LA. Epidemiology of cervical cancer—overview. IARC Sci Publ. 1992;119:3.
  5. View Abstract: Schneider A, Shah K. The role of vitamins in the etiology of cervical neoplasia: An Epidemiologic review. Arch Gynecol Obstet. 1989;246:1.
  6. View Abstract: Morris M, Tortolero-Luna G, Malpica A, et al. Cervical intraepithelial neoplasia and cervical cancer. Obstet Gynecol Clin North Am. Jun1996;Vol 23(2):347-410.
  7. Reichman RC. Human Papillomavirus Infections, In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill; 1998:1099.
  8. American Cancer Society. Cervical cancer fact sheet. Revised. Feb2000.
  9. View Abstract: Butterworth CE Jr, at al. Folate deficiency and cervical dysplasia. JAMA. Jan1992;267(4):528-33.
  10. View Abstract: Butterworth CE Jr. Effect of folate on cervical cancer. Synergism among risk factors. Ann N Y Acad Sci. Sep1992;669:293-9.
  11. View Abstract: Kwasniewska A, et al. Folate deficiency and cervical intraepithelial neoplasia. Eur J Gynaecol Oncol. 1997;18(6):526-30.
  12. View Abstract: Buckley DI, et al. Dietary micronutrients and cervical dysplasia in southwestern American Indian women. Nutr Cancer. 1992;17(2):179-85.
  13. View Abstract: Butterworth CE Jr. Oral folic acid supplementation for cervical dysplasia: a clinical intervention trial. Am J Obstet Gynecol. Mar1992;166(3):803-9.
  14. View Abstract: Zarcone R, et al. Folic acid and cervix dysplasia. Minerva Ginecol. Oct1996;48(10):397-400.
  15. View Abstract: Wylie-Rosett JA, et al. Influence of vitamin A on cervical dysplasia and carcinoma in situ. Nutr Cancer. 1984;6(1):49-57.
  16. View Abstract: Mackerras D, et al. Randomized double-blind trial of beta-carotene and vitamin C in women with minor cervical abnormalities. Br J Cancer. Mar1999;79(9-10):1448-53.
  17. View Abstract: Wassertheil-Smoller S, et al. Dietary vitamin C and uterine cervical dysplasia. Am J Epidemiol. Nov1981;114(5):714-24.
  18. View Abstract: Liu T. A case control study of nutritional factors and cervical dysplasia. Cancer Epidemiol Biomarkers Prev. Nov1993;2(6):525-30.
  19. View Abstract: Mackerras D, et al. Randomized double-blind trial of beta-carotene and vitamin C in women with minor cervical abnormalities. Br J Cancer. Mar1999;79(9-10):1448-53.
  20. View Abstract: Palan PR, et al. Plasma levels of antioxidant beta-carotene and alpha-tocopherol in uterine cervix dysplasias and cancer. Nutr Cancer. 1991;15(1):13-20.
  21. Hillebrand H. The Treatment of Premenstrual Aphthous Ulcerative Stomatitis with Agnolyt. Z Allgemeinmed. 1964;40(36):1577.
  22. McGibbon D. Premenstrual syndrome. CMAJ. 1989;141(11):1124-25.
  23. View Abstract: Jarry H, et al. In Vitro Prolactin But Not LH and FSH Release Is Inhibited by Compounds in Extracts of Agnus castus: Direct Evidence for a Dopaminergic Principle by the Dopamine Receptor Assay. Exp Clin Endocrinol. 1994;102(6):448-54.
  24. View Abstract: Monograph:Bromelain. Altern Med Rev. Aug1998;3(4):302-5.