Heading Off Cervical Cancer

By Diana Somerville

Routine screening has made this disease almost entirely preventable, but the virus that causes it still runs rampant. Simple precautions, a healthy diet, and regular checkups can keep it under control.

Abnormal Pap results. Those three words can instill fear in the bravest and most health-savvy woman. The mind goes immediately to cervical cancer, a disease that, according to the National Cervical Cancer Coalition, claims the lives of 3,900 women in the US each year.

But in fact, abnormal results are far from a death knell. Some mild abnormalities stem from inflammation or irritation caused by a mild yeast or bacterial infection. However, the abnormal results can also signal cervical dysplasia, abnormally shaped cells in the cervix that can be a precursor to cervical cancer. Detected early, cervical dysplasia is entirely treatable, but of course it’s better not to develop the condition in the first place.

Most cases of cervical dysplasia result from an HPV infection. While transmissible by any skin-to-skin contact, HPV, the human papilloma virus, is so commonly transmitted by sexual activity that it’s considered a virtual marker for having had unprotected sex. Generally, the immune system can handle HPV, which is often symptomless, and outbreaks of the virus come and go like an unremarkable cold. But when the virus persists or comes from a high-risk strain, it can cause cervical dysplasia. For that reason alone, it’s important to understand HPV and to learn how to prevent it and—if you already have it—how to treat it.

Identifying HPV

Doctors and researchers have isolated more than 100 strains of HPV. Some cause the benign but annoying warts that pop up unexpectedly on your hands or feet, but at least 30 strains can infect the genital area, silently lurking in the skin and mucous membranes for months or even years. HPV is transmitted by skin-to-skin contact, which means you can unwittingly infect your partner—or vice versa.

Once you’re sexually active, your health routine should include a pelvic exam and Pap test, in which cells are gently scraped from the uterus and cervix and smeared on a slide that’s examined under a microscope. The widespread use of the Pap test or Pap smear, developed by George Papanicolaou, MD, more than 60 years ago, has reduced cervical cancer deaths by more than 70 percent in the US.

“A Pap smear is a true screening test,” says Bethany Hayes, MD, OB/GYN. “It’s relatively noninvasive, relatively inexpensive, and picks up abnormalities early enough to do something about them.” Hayes is the medical director of True North Health Center, an integrated holistic healthcare center in Falmouth, Maine.

Not all abnormal Pap results call for great concern, but they do indicate a need for follow-up with a healthcare provider to determine the cause of the abnormal results. The Pap itself is not diagnostic, stresses Tori Hudson, ND, professor of gynecology at the National College of Naturopathic Medicine, in Portland, Oregon. “It indicates if you need very early treatment; it shows whether you need a colposcopy and a biopsy.”

A colposcopy is a high-tech visual procedure that gives the practitioner a close-up internal look, using a special magnifying lens (colposcope), at the vagina and cervix. The procedure might also include staining the cervix with an iodine or vinegar solution to increase the visual contrast between normal and problematic cells. In the same session, your healthcare practitioner may take little snippets of tissue for a laboratory biopsy.

For people who undergo regular screening and have had abnormal results for the first time, many healthcare practitioners, including Hudson, recommend a conservative approach. “If you’ve never had an abnormal Pap and your results are only mildly abnormal, then watching and waiting and using natural medicine for three to six months before retesting makes the best sense,” Hudson says. “If, on your Pap, we see what are called ‘low-grade’ or ‘high-grade’ lesions, we recommend a colposcopy and biopsy.”

Another option is testing for high-risk HPV DNA strains. Of the HPV strains that can infect the genital area, about a dozen cause cervical dysplasia and four are deemed high-risk for cervical cancer. HPV-16 is linked with more than half of cervical cancer cases, HPV-18 accounts for about 12 percent, and HPV-31 and HPV-45 for about 5 percent apiece.

Joel Evans, MD, OB/GYN, and author of The Whole Pregnancy Handbook (Gotham Books, 2005), cautions that there may be no clear line between high- and low-risk HPV, just as the herpes virus was once divided into two types (oral and genital) until researchers found crossover between the types. “The same is true here,” he says. “The difference is important in determining the risk of developing cancer, but I emphasize that it makes no difference in terms of transmissibility or the need to practice safer sex.”

Though HPV can be blamed for something like 90 to 99 percent of cervical dysplasia, not all HPV infections result in dysplasia. Not all dysplasia turns into cervical cancer, either, and it’s typically a long process when it does—good news for women who are diagnosed with dysplasia during a regular screening. “It’s a slow process, taking months or years,” Evans says. “The cells go through standard stages from mild, to moderate, to severe. And if you spot dysplasia early on, it’s very treatable and cancer is prevented.”

Tune your immune system

A robust immune system helps combat HPV, although lifestyle factors also play a role in determining the course of an infection. Women who smoke and those who have poor nutrition and low antioxidant levels are more likely to develop cervical cancer. Typical STD risks such as beginning sexual activity at a young age and engaging with multiple partners are also warning signs.

Hayes adds genetics to the list of risks. She recommends genetic testing for the combining gene MTHFR, which is involved in the body’s ability to activate folic acid and read viral DNA messages. “About 20 percent of the population has a funny copy of this gene,” she says. People who do may also be more vulnerable to heart disease. If you learn that you have it, Hayes recommends supplementing with activated folic acid. Of course, your best option is to avoid HPV, she adds. “Use barrier contraceptive methods, limit the number of sexual partners, and interview your partners about sexually transmitted diseases and their number of sexual partners.”

Food plays a huge role in prevention, according to Jane Guiltinan, ND, director of the Bastyr Center for Women’s Wellness in Seattle. Epidemiological studies show that dietary components associated with a lower risk of developing cervical dysplasia include lycopene, vitamin A, zinc, vitamin C, and folic acid. It’s important to eat fresh fruits and vegetables and a diet rich in antioxidants, she stresses, rather than simply taking supplements—with some exceptions. The first is I3C (indole-3-carbinol), an extract of cruciferous vegetables. “Treating dysplasia with 200 and 400 mg of I3C a day for 12 weeks produced a complete reversal of dysplasia for 40 to 50 percent of the women [in a research study],” she reports. The higher dosage produced no difference. Also green tea, either orally (five cups per day) or as an extract in a topical gel, has been proven effective in reversing dysplasia, she adds.

Evans recommends a “pescatarian” diet, which includes fish and organic whole foods with complex, low glycemic-index carbohydrates, low fat, and very little dairy. He also points out the importance of managing stress, eating properly, and sleeping enough. When it comes to supplements, he prescribes folic acid, mixed carotenoids, I3C, CoQ10, and drinking green tea.

“A woman can treat most mild abnormalities herself,” says Hudson. Green tea extract is so effective, she says, that you could simply try inserting green tea capsules vaginally twice a week in addition to taking green tea supplements. A second Pap test will reveal if the treatment has worked.

If the infection has progressed from dysplasia to low-grade lesions, “you’ll really want to seek an alternative practitioner who knows treatments, when to treat, and when to get the cells removed,” Hudson advises. Troublesome tissues can be removed with a scalpel, a laser, or by freezing. These treatments are successful at least 90 percent of the time, Hudson says. The most common is a treatment called LEEP (loop electrosurgical excision procedure), done in-office under local anesthetic. LEEP spares the good underlying tissue while providing a biopsy specimen.

If you do need to undergo a surgical procedure, Guiltinan recommends taking multivitamins, increasing your intake of antioxidants, and adding I3C and 10 mg of folic acid a day. After the wound heals, she says to focus on green tea—both topical and oral. The aim: “To keep your immune system functioning as optimally as you possibly can.”

Only the most invasive infections require the most drastic treatment—a hysterectomy. But between self-treatment and hysterectomy lies a staircase of decisions you need to make with your healthcare practitioner, who can offer a host of treatment choices that most conventional gynecologists probably won’t mention.

More ways to defeat cervical cancer

Recent improvements in preparing Pap samples, called “wet-preps,” produce easier-to-read results and are routinely recommended for women over 30. Wet-preps also allow for DNA testing. And a new DNA HPV test developed by Digene Corporation, DNAwithPap, can tell you if high-risk HPV strains are present. Major pharmaceutical companies are now testing vaccines against some HPV types, and they may be available within a year.

Testing and treatment have made cervical cancer almost entirely preventable for women with access to healthcare. The outlook in developing countries, where healthcare resources for women are thin to nonexistent, is gradually improving, too. New, low-cost screening methods, including urine tests, dry- cell collection, and automated analysis, are in the works. They may help reduce the disproportionate number of poor women who still die from this largely preventable cancer.

HPV is no modern malady. Greek and Roman physicians reported its symptoms more than 2,000 years ago. And while it’s likely to stick around for a while, at least it’s causing less cervical cancer than it used to. With more widespread screening and treatment, there’s hope that cervical cancer may soon go the way of smallpox—or the dodo.

The Other HPV Issue

• HPV’s other manifestation, though not as daunting as cancer, is troubling in its own way. Genital warts can appear within weeks of having sex with someone with HPV, or they may lie dormant for months or years. They may show up as flesh-colored to white-colored growths or bumps—raised or flat, single or multiple, small or large—like warts elsewhere on the body.

• If you suspect you’ve been exposed to HPV, visit your healthcare practitioner, since warts are sometimes hard to see. A good diagnosis may require an experienced eye. Your practitioner might decide any odd-looking bump should be biopsied in order to check for suspicious cellular changes. External warts can be treated using a prescription cream, or your practitioner can remove them by freezing, cutting, or burning. Don’t even think about applying over-the-counter remedies to tender genital tissues.

• Using a condom from the start of intercourse through the end reduces your risk, but condoms provide protection only for the skin that they cover, not the entire genital area.

Resources

• American Social Health Association National HPV & Cervical Cancer Resource Center 877.HPV.5868 • http://www.asha.org/

• National Cervical Cancer Prevention Resource Center http://www.cervicalcancercampaign.org/

• Women’s Cancer Network 312.578.1439 • http://www.wcn.org/

• Learn more, connect, or chat at http://www.hpvforum.com/