Therapeutic Approach to abnormal Papsmear

As mentioned in the previous article (Factors that can contribute to an abnormal Pap smear), the careful monitoring of any cervical cell abnormality by your doctor or gynaecologist is essential. The additional therapeutic approach depends on the severity of the dysplasia. If the Pap smear indicates benign cell abnormalities (CIN 1 or CIN2) the recommendations outlined by one of our Naturopaths can quite often be employed with careful monitoring (which means getting a Pap smear every three months until the results are normal). However if the Pap smear demonstrates significant dysplasia (CIN3), it must be first ascertained whether there is cancer involved. Diagnosis and treatment of CIN 3 pap smears usually includes either a cone biopsy or loop electrical excision procedure (LEETZ). These procedures remove a piece of the cervix which not only gets rid of abnormal cells, but determines whether localised cancer of the cervix (carcinoma in situ) has developed. A CIN2 Pap smear should also be biopsied if a woman has recurrent abnormal Pap smears, has significant risk factors for cervical cancer, or does not respond to the therapy outlined by your Naturopath within three months. Treatment Approaches: Eliminate Risk Factors When cervical dysplasia is present the first step is to eliminate risk factors (outlined in previous article) where possible, and to optimize one’s nutritional status. Diet •            Reduce fat intake (especially animal fats) to no more than 25% of the diet. •            Increase fruit and vegetables in the diet and eat organic whenever possible (especially green leafy vegetables). Fruit and vegetables are said to provide the best polypharmacy against the development of malignancy in tissue. •            Increase fibre content in the diet (increasing fruit and vegetables should help in this regard) •            Consumption of animal products should be decreased. Fish and legumes should be increased. Certified organically fed chicken and red meat may be consumed if the fat is trimmed. •            Avoid tea and coffee. Dandelion coffee substitute, green and herbal teas are preferred. •            Whole grain bread / rice / pasta and organic whenever possible. Avoid refined flour products. •            Avoid too much sugar and sweet foods such as honey and undiluted fruit juices •           Spinach should be included on a regular basis -  Substances in spinach can imprison and paralyse the virus that would otherwise cause cervical cancer. •            Research has found that those with higher levels of folic acid (found in green vegetables such as broccoli, spinach and asparagus) and lycopene (a tomato compound) are much less vulnerable to cervical dysplasia and cervical cancer. •            Increase sources of Beta Carotene - Low levels of beta-carotene are often found in those with cervical dysplasia and cervical cancer. Major sources of beta-carotene are dark orange and green vegetables. Sweet potatoes, carrots, dried apricots, kale spinach and pumpkin have the most. In addition to these guidelines, more specific recommendations are often required and can be tailored by one of our Naturopaths. Supplementation Vitamin and mineral deficiencies play a major role in the onset of cervical dysplasia. In conjunction with the above dietary changes and eliminating the risk factors for cervical cell changes (where possible), our Naturopaths can prescribe specific nutritional supplements and herbs to improve the health of the cervical cells and to increase the chances of reversing any abnormality. There is much literature suggesting there is a role for nutrients and herbs in the prevention and reversal of cervical dysplasia. If you would like more information or to make an appointment with Lisa or one of our experienced Naturopaths, please call the clinic on 02) 9976 5466

Factors that contribute to an abnormal Papsmear

According to the NSW cancer council 1 in 10 pap smears shows some abnormality. These cell changes in the cervix can vary in severity from mild, reversible changes to cervical cancer.
 
Women can lower their risk of cervical cancer by avoiding the high risk factors that have been linked to the development of cervical cell abnormalities and the subsequent progression of these changes to cervical cancer.
 
What does an abnormal Pap smear mean?
Pathological processes in the cells for the cervix can give rise to a spectrum of changes that can all show up as abnormal on a Pap smear. Some atypical cells are benign and may be due to bacterial, fungal or viral infections. Changes can also result in cervical intra-epithelial neoplasia (CIN), also known as dysplasia. CIN has the potential to become invasive cervical cancer. CIN is graded into 3 stages of severity.
 
Table 1 below (adapted from Murray and Pizzorno) outlines and compares the classification systems for cell changes.

These are the main classification systems that health care practitioners will refer to.
 

Dysplasia	CIN*	Bethesda System
Benign	Benign	Normal
Benign with inflammation	Benign with inflammation	Normal
Mild dysplasia	CIN I	Low grade SIL**
Moderate dysplasia	CIN II	Low grade SIL
Severe dysplasia	CIN III	High grade SIL
Carcinoma in situ	CIN III	High grade SIL

 
^* CIN = cervical intraepithelial neoplasia
^**SIL = squamous epithelial lesion
 

 
Risk factors
The risk factors for cervical dysplasia and cervical-cancer are similar, and are largely attributed to lifestyle and nutritional factors. Smoking cigarettes, sexual activity, acquiring certain viruses, using oral contraceptives, immune suppression, and nutritional deficiencies are just some of the risk factors that increase the chances of developing cervical dysplasia and cervical cancer.

• Viruses

Certain viruses increase the likelihood of the development of abnormal cells. These are Human Papilloma Virus (HPV) and Herpes Simplex Type 2 (HSV-2).
Although HPV is usually present in women with cervical dysplasia and cervical cancer, the vast majority of women with HPV do not develop CIN or cervical cancer. It is thought that other factors such as smoking and poor nutrition need to be present in addition to HPV to promote the development of CIN. Thus the presence of HPV alone does not seem sufficient to cause cervical cancer in most cases.

• Smoking

Smoking (including passive smoking) has been associated with cervical cancer and cervical dysplasia. Studies demonstrate a modest but significant increase in the relative risk with smoking. Smoking has been shown to depress the immune system and induce vitamin C deficiency which may contribute to the development of abnormal cells.

• Sexual activity

Cervical dysplasia and cervical cancer are related to sexual intercourse. It is extremely rare in nuns, and women who have never engaged in sexual intercourse have very little risk of developing cervical cancer. In addition to this, the incidence increases with early first intercourse and early child bearing.

• Oral contraceptives

The use of oral contraceptive pills can lead to immune depression and in this way predispose a woman to cervical changes. The use of oral contraceptives (especially long term use) can decrease numerous nutrient levels which are involved in immunity.

• Nutritional factors

Vitamin and mineral deficiencies play a major role in the onset of cervical cell changes.
A high fat intake has also been linked to cervical cancer, while a diet high in vegetables and fruits is believed to protect against cervical cancer.
Several studies demonstrate the definite association between cervical dysplasia and deficiencies in folic acid, vitamin C, selenium, vitamin A and beta-carotene.
Other nutrients also associated with changes in the cervix include B vitamins and zinc.
There is much literature suggesting that there is a role for nutrients in the prevention of cervical dysplasia and cancer.

• Lack of biannual Pap smears

Fortunately, Cervical cancer is one of the few cancers that has well-defined precancerous stages, and having regular Pap smears means that cell changes can be detected and treated early before they become cancerous.
 
As outlined above, there are various risk factors that can be avoided to reduce the chance of developing cervical dysplasia and cervical cancer. There are also many nutritional factors that have been shown to reverse early dysplasia.

If you would like more information, please contact one of our Naturopaths at the clinic on 

9976 5466