Excerpts from Chapter 10:
Lifestyle and Cervical Cancer Prevention
AND HPV RISK | CIGARETTE SMOKING
NUTRITION | OPTIMIZE YOUR
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.
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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.
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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
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.
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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
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.
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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
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