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Abnormal Pap SmearsAbnormal Pap Smears

Excerpts from Chapter 10:
Lifestyle and Cervical Cancer Prevention


One of the great unknowns in cervical cancer research has to do with why relatively few women go on to develop the disease despite the large number who become infected by HPV. Remember that while a cervical infection with HPV is necessary for the formation of cervical cancer, only a very small percentage of all women with HPV infections actually go on to develop cervical precancers or cancer. What is it about that small percentage of women that allows this process of cervical cancer formation to move forward?

We have stated before that poorly understood immune differences and possibly some hormonal factors are currently thought to cause an HPV infection to regress in one woman but develop into a cervical lesion in another woman. Many of these differences, undoubtedly, have to do with the way our immune systems function which may be genetically based. This might explain at least some of the increased susceptibility to cervical cancer that we see with different ethnic groups such as African American, Hispanic, and Native American women.

Clearly, there is not much that we can do about our genetic or ethnic backgrounds, but what about the things which we can change about our lives, such as nutrition or stress control? It is currently very fashionable to speak about improving immune function with various diets or exercise regimens and there are many popular books on this topic. But is there any truth to these claims? Is there an optimum cancer prevention lifestyle and if so, are there any data specific to cervical cancer prevention?

While we applaud any woman who uses a diagnosis of a cervical abnormality to examine her life and then decide to make healthy choices, we must emphasize that research in the area of a cancer prevention lifestyle is, at best, "soft." Unlike some of the more rigorous studies on the association of HPV with cancer, the studies which look at correlations between nutritional and other factors in cervical cancer prevention tend to be less definitive and should be interpreted cautiously. Despite this, it is also true that most of the suggestions coming out of this type of research tend to be generally good for overall health. In this chapter, we will discuss some of the current thinking with regard to cervical cancer risk and lifestyle factors.


Teens and HPV Risk

If you are a teen reading this book, the mother of a young teen or a health care professional or educator who works with teen-agers, recall that these young women are at particular risk for the development of an HPV-related lesion. As we discussed in chapter three, the maturing female cervix is undergoing changes which make precancerous lesions with HPV infection more likely. Young teens are much less likely to have transient and harmless HPV infections.

It is difficult to advise abstinence these days since we are surrounded with suggestive imagery from the television screen to advertisements at the bus stop, but it is a good idea for young teens under the age of fifteen purely from a cervical cancer prevention standpoint. Young teens should obviously be provided with information on the prevention of STDs and pregnancy prevention with birth control. As with any discussions with teens, there is the important goal of keeping communication lines open and not alienating them by resorting to scare tactics. However, from a cancer prevention point-of-view, very young women should consider abstinence.


Cigarette Smoking

A woman can add increased susceptibility to cervical cancer to the long list of reasons why you should quit or never start smoking. In some studies, this increased risk is estimated to be at least two times greater than that seen in non-smokers. There appears to be some subtle interactions between HPV infected cervical cells and substances found in cigarette smoke which promote cervical cancer development.

Aside from increasing a woman's risk of cervical cancer, there are other excellent reasons to quit smoking. These include the damage to children, starting from exposure during a woman's pregnancy and the risk of low birth weight. Later exposure after birth increases a child's risk of serious respiratory problems such as asthma and allergies. More and more damaging information is accumulating on the role of second hand smoke in promoting cancer (particularly lung cancer) in innocent bystanders inhaling someone else's smoke.

This discussion is in no way intended to minimize the difficulty in quitting such a highly addictive habit. If you are a woman who has tried to quit but has failed using standard therapies, it is worth taking a second or even third or fourth look at quitting smoking. Recent studies indicate that there seems to be sex differences in which strategies are the most effective for long-term smoking cessation in women compared with men. For example, nicotine replacement with patches or gum is usually the first line of therapy but this is often less effective with women. The American Cancer Society is an excellent resource for information on different methods to quit smoking. A phone call to your local chapter may help get you started. It is well worth whatever effort you need to put into this endeavor.



It has been known for some time that certain types of diets, in particular those which are rich in fruits and vegetables, seem to confer a "cancer protective" effect. Vegetarians tend to get less of certain types of cancers. From these observations, however, it has not been possible to clearly differentiate whether this cancer protective effect is due to the actual ingestion of plant foods or whether it is due to the fact that vegetarians do not eat meat. Lately, with studies into the micronutrients contained in plant foods, it seems probable that the protective effects of eating vegetables are due to one or more components of the fruits and vegetables themselves.

Much recent research has focused on antioxidants which are chemical substances contained in foods such as fruits and vegetables. These substances have the effect of preventing damage to a cell's DNA. This is critical for halting the progression of a cell towards malignant transformation since DNA damage is the first step in this process. Mother Nature has actually made it quite simple to choose foods which are rich in antioxidants since these substances are contained within fruit and vegetable pigments. So choosing brightly colored fruits and vegetables such as red peppers, plums, dark leafy greens, tomatoes and pumpkins will guarantee that you are taking in good doses of these important chemicals.

As far as traditional vitamin supplements, most nutrition experts and physicians are in agreement that a standard multi-vitamin pill is probably good nutritional insurance. Many researchers and clinicians alike are also recommending supplemental vitamin E, up to 400 IU daily, since this vitamin is very difficult to get through dietary means and it seems to confer both a cancer reducing as well as a heart protective effect. Folic acid is also an important nutrient for women since it protects against several devastating birth defects. You should make sure that your multivitamin contains folic acid.

Do any of the above recommendations hold specifically for cervical cancer? Research in this area is promising although the studies taken together offer inconsistent results. Dr. Walter Willett, professor of Epidemiology and Nutrition and chairman of the Department of Nutrition, Harvard School of Public Health, he "is not aware of any convincing data that antioxidants, folic acid, vitamin C, or vitamin A will reverse abnormal cervical cytology." As we mentioned in the beginning of this chapter, it can be exceedingly difficult to figure out the precise effects of a particular vitamin or nutrient (vitamin C, for example) while controlling for all other "confounding" factors such as smoking. Also keep in mind that reliable HPV testing is a relatively recent advance so that earlier studies were not able to use positive or negative HPV results in looking for the protective effects of various nutrients.

As summarized in a recent issue of Alternative Therapies in Women's Health, studies of cervical disease and diet, for the most part, have shown an inverse association between the risk of cervical cancer and dietary intake of dark green and yellow vegetables, beta-carotene, and vitamins C and E. In other words, the higher the intake of these foods and nutrients, the less chance for development of cervical disease. The studies which have looked at using nutrients as "medicines" in "interventional studies" have been less successful in substantiating the cancer preventative role that nutrients can play.

For the time being, as we await the research on cervical cancer and nutrients to sort out, it seems to make good health sense to increase your intake of fruits and vegetables, with the official USDA recommendation being five fruits and vegetables a day. This recommendation is probably a little on the low side and we could all benefit from eating more plant foods.


Optimize Your Immune System

A healthy well-functioning immune system is absolutely essential to your overall health and well being. It is your immune system which prevents potential damage from foreign substances such as microorganisms and carcinogens. It is also responsible for getting rid of HPV before it can cause precancerous and cancerous changes in your cervix.

We all know a properly functioning immune system acts to fight infections by microorganisms. There is also growing evidence for a role for your immune system in fighting or preventing cancer by recognition and destruction of cells in your body which have undergone cancerous mutations due to exposure to carcinogens, free radicals or other events. This is evident in individuals with impaired immune systems who are at a higher risk for cancer. Beyond this fact, can people with well-functioning immune systems lower their cancer risk by boosting their immune systems? The answer is not at all clear although some studies offer tantalizing suggestions that this may be the case.

Most investigators would likely agree, however, that it is wise to limit your exposure to harmful chemicals and radiation. We still don't completely understand the damage to our cells which can occur from exposure to a variety of chemicals, damage that possibly may result in cancer-causing mutations. These can also theoretically stress your immune system and, if prolonged, could result in your immune system not functioning at its best increasing your susceptibility to cancer, among other diseases. If you work or have hobbies where you are exposed to solvents or other chemicals, make sure that you are following all of the manufacturer's recommendations in terms of not breathing fumes for an extended time.

Another area of controversy has to do with the effect of emotional stress on your immune functioning. We all know of instances where we became ill after marked emotional stress in our lives, whether at our work, school or in social relationships. It is a difficult area for our scientists to document but there is an undeniable association between our minds and our bodies and our immune systems can often be the victim of things not going well in our lives. Some scientists have speculated that chronic stress can depress your immune system in ways that render you more susceptible to cancer. Whether this is in fact true or not, chronic stress is not a very pleasant backdrop to our lives and we heartily endorse whatever methods you find help you with stress relief.

Ways to reduce stress are many and lend themselves to being individualized for what works for you. Many women find meditation a valuable way to calm the mind and gather resources to face our often-hectic and stressful lives. Yoga is an excellent way to incorporate mental relaxation and flexibility, and balance. A nice massage or bodywork of some kind is also an excellent outlet for mental stress, which can get locked into our physical bodies. Good honest aerobic exercise is the trick many women use to combat stress in their lives. Strength training with weights is also a wonderful stress reliever and gives you the added benefit of looking and feeling strong.

Lastly, do not underestimate the importance of friends in your life. A good friend can make the darkest events in your life much more tolerable. A great friend can make you laugh about them. Women have traditionally reached out to each other during times of crisis because this is a stress-reducing maneuver that works. It is recommended that you "mix it up". In other words, demonstrate diversity in your choices of stress-busters. Make room in your life for a combination of the above, aerobic exercise, yoga, meditation, massage and a long chat with a good friend.

The above discussion points out how much we have yet to learn about the various effects of our lives on HPV infection and cervical cancer. If you are a woman with cervical disease, consider this an opportunity to examine your lifestyle choices in a number of areas. And don't forget to get those regular Pap smears! More than ever, we as women, have the power to shape our own futures and enjoy a healthy, cancer-free old age.



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