Cervical Cancer Prevention

Though sometimes overshadowed by the push for breast cancer awareness, cervical cancer prevention has acquired some of the spotlight in recent years with the introduction of Gardasil (the HPV vaccine). But a shot isn't the only remedy, or the appropriate one in all cases. Education is the best prescription for this highly preventable cancer.

Cancer of the cervix is found in the tissue at the base of the uterus, the lower section of the womb.  This particular form of cancer still effects nearly 12,000 women a year with approximately 3,850 deaths [Source: CDC]. Unlike other cancers that are often not detected until late in their progression, cervical cancer can be detected very early through routine Pap smears. This test is done typically at age 21 or three years after the patient becomes sexually active, whichever comes first. The great benefit of the Pap smear is that it can detect progressive changes in the cervix before a true diagnosis of cancer is made. These mutations are called cervical dysplasia or neoplasia. Once detected, treatment can be done to hault progression into cervical cancer. Over half of the women diagnosed with cervical cancer either have never had a Pap smear or have not been tested in the five years prior to the diagnosis [Source: NIH].

Several causes promote cancerous changes in the cervix, but one of the most researched associations is that of the human papilloma virus (HPV). It is estimated that 6 million new HPV infections occur each year and several forms (up to 100) of this virus may exist [Source: Cates, Erb].  Even though estimates suggest that well over half of women may be infected by age 50, most will remain asymptomatic [Source: Erb]. Among the various types of HPV, some are more dangerous than others in regard to cervical cancer risk. A newer vaccine, Gardasil, protects against four types of HPV, including two of the more dangerous subtypes.

Statistics show that thousands of women are exposed to at least one of the subtypes of HPV and do not get cancer. Most likely, this means that lifestyle and diet play a major role in the development and thus prevention of cervical cancer. In fact, lifestyle is known to influence cervical cancer in two specific areas.

The first is smoking. Female smokers are known to be at a higher risk for the development of cervical cancer [Source: Plummer]. Any smoker who has had an abnormal Pap smear needs to seriously consider quitting. It's a factor that could significantly harm many areas of the body, and makes it that much harder to treat cancerous changes of the cervix. The second factor that dramatically impacts cervical cancer risk is unprotected intercourse with multiple partners. Choosing to use condoms, and avoiding the use of tobacco can provide substantial protection against HPV, and the development of cervical cancer cells.

On the next page, learn more about dietary and lifestyle habits that can help in preventing cervical cancer.

Dietary and Lifestyle Habits for Prevention

Folic acid tops the list of nutrients that have been shown to reduce changes in the cervix related to cancer, with inadequate levels associated with high risks of cervical cancer [Source: Piyathilake]. Unfortunately, food sources of folic acid may not be enough [Source: Shikany]. Women might need to supplement the nutrient to protect the cervix, but folic acid is safe and tolerated well. Typical dosing should be 400-800 micrograms daily. Any woman of childbearing age should take folic acid to help prevent fetal neural tube defects with pregnancy.

Other vitamins, including thiamine (B-1), riboflavin (B-2) and B-12 can also help fight cervical cancer [Source: Hernandez]. These vitamins are all found in a B complex supplement that can be taken daily for prevention. The vitamin needs to complement a diet high in vegetables, especially leafy greens. Dietary B-12 typically comes from animal sources, so vegetarians may need to supplement. Smokers tend to be lower in these vitamins as well [Source: Hernandez].

The diet should also target numerous servings of cruciferous vegetables (broccoli, cauliflower, Brussels sprouts) each week. These provide Indole-3-carbinol (I3C, for short), which helps the body metabolize its estrogens through a healthier path in the liver. Data supports the helpful effect 13C and the metabolite diindolylmethane (DIM)  have against hormone-related cancer cells in both the breast and cervix [Source: Chen, Aggarwal]. Broccoli is a great choice for cancer prevention, typically testing low in pesticide residues. For those wanting extra benefits of I3C or DIM, take supplements at dosages of 400-500 mg of I3C or 200-300 mg of DIM daily. 

Females with a family history of cervical cancer or other hormone-related cancers like breast cancer may need to be more aggressive in their lifestyle and dietary habits for prevention. A strong family history of cancer requires cutting out the cigarettes and adding more vegetables to the diet. Folic acid or B complex supplementation would also be strongly suggested. DIM or I3C can help bolster the body's defense against a genetic propensity for cancer.

Go on to the next page to learn about the HPV vaccine as a medical option for preventing cervical cancer.

The HPV Vaccine

The Gardasil vaccine has garnered much attention for its claims to prevent certain types of the human papilloma virus (HPV) infection, a virus strongly linked to cervical cancer. By preventing HPV, the vaccine strives to provide the basis for cervical cancer prevention. But as with all treatments, several questions do arise like, "Does every woman need this vaccine?" and "Who would benefit most from this treatment?" An explanation of the risks and benefits can help target those who should look into this method.

In the United States, nearly 12,000 women are diagnosed with cervical cancer each year, with over 3,800 deaths [Source: CDC]. As mentioned, HPV is strongly linked to the origins of cervical cancer. But it's not as simple as saying that if a woman has the virus that she will get cancer. There are several subtypes of the virus, up to 100, some of which are more strongly considered cancer-causing [Source: NIH]. In fact, some research suggests that up to 6 million women are infected with some type of HPV each year [Source: Cates]. Fortunately, among those several million, only about 0.2 percent develop cervical cancer, with only a quarter of that group succumbing to the disease. This of course is still too many, but it does mean that there are factors beyond HPV that effect how well the body maintains the health of the cervix.

The advent of this vaccine has led to a mass marketing concept appealing to concerned parents who may have had no previous knowledge of HPV. Education is very important here. Aside from the potential problems from the viral infection, perhaps the two greatest risk factors for cervical cancer are smoking and unprotected intercourse with multiple partners. The vaccine is approved for females ages 9-26, which can put the decision in the parents' hands. Unfortunately, some parents are fearful they are letting the system down if they don't choose the vaccine. In truth, the vaccine will benefit some patients more than others. Girls who continue to smoke will put themselves at higher risk for cervical changes. Also, patients who practice unprotected intercourse with many partners can also be at higher risk as the probability of contracting multiple types of HPV rises.

Read about the pros and cons of the HPV vaccine on the next page.

Pros and Cons of the HPV Vaccine

The pros and cons of this vaccine need to be weighed. For example, the shot is recommended for children as young as age 9. The goal of course is to protect young girls before they would actually become sexually active. However, it is really unknown at this point how long the vaccine lasts in the body. A child vaccinated too early may need to be revaccinated at 15. This means the protection may wane before the timeframe when the child is actually at risk. The HPV vaccine is not without side effects. From the time it was introduced in 2006 to the end of June 2008, 9,749 adverse events were reported [Source: Piyathilake]. These accounts included 21 reports of death and 44 reports of Guillain-Barre syndrome (a form of paralysis). Most likely the vaccine is not fully responsible, though it does mean that caution and better judgment need to be used before a blanket statement to vaccinate every 9-year-old girl is issued. Even with the vaccine, patients will remain unprotected against the other 90-plus types of HPV they're exposed to without the use of condoms.

All women of childbearing age need to be aware of the importance of folic acid to prevent a certain type of birth defect in developing babies. Folic acid is most helpful if it is taken before the actual pregnancy takes place. Fortunately, folic acid also seems to show significant benefit in protecting the body against cervical cancer [Source: Erb, Plummer]. Folic acid is very easy to supplement, well tolerated, and can be taken at 400-800 micrograms daily.

Another way of preventing the onset of cervical cancer is the Pap smear. This test takes cells from the cervix for microscopic evaluation. Since the Pap smear's inception, cervical cancer has gone from the number 1 killer of women to number 15. Testing should begin 3 years after first intercourse or at age 21, whichever occurs first. Now, technology has allowed the testing of specimen for high-risk types of HPV to help focus on those at the highest risk of cancer.

When deciding whether to pursue the vaccine, patients and parents need to have an open discussion about risks, benefits and lifestyle choices that may effect cervical cancer risk. The vaccine is not without risks itself and does not protect against all types of HPV. Education, not fear, should lead this decision along with open, receptive communication between the parents, doctor and patient.

Lots More Information

Related Articles

• How the Cervical Cancer Vaccine Works
• Cervical Cancer Facts to Know
• Cervical Cancer Lifestyle Tips
• How Cancer Works

Sources

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• National Institutes of Health. Cervical cancer: NIH consensus development conference statement. 1996;14:1-38.
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• Plummer, M., Herrero, R., Franceschi, S., et al. (2003). Smoking and cervical cancer: pooled analysis of the IARC multicentric case-control study. Cancer Causes Control, 14. 805-814.
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• Hernandez, BY. (2003). Diet and premalignant lesions of the cervix: evidence of a protective role for folate, riboflavin, thiamin, and vitamin B12. Cancer Causes Control, 14(9): 859-70.
• Chen, DZ. (2001). Indole-3-carbinol and diindolylmethane induce apoptosis of human cervical cancer cells and in murine HPV16-transgenic preneoplastic cervical epithelium. J Nutr, 131(12):3294-302.
• Aggarwal, BB. (2005). Molecular targets and anticancer potential of indole-3-carbinol and its derivatives. Cell Cycle, 4(9):1201-15.
• U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2007. From the CDC Web site: http://www.cdc.gov/cancer/cervical/
• Erb, T. (2008). Update on infectious diseases in adolescent gynecology. J Pediatr Adolesc Gynecol. 21(3): 135-43.
• Cates, W. (1999). Estimates on the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association panel. Sex Transm Dis 26. (4 suppl):S2.
• Piyathilake, CJ. (2008). Mandatory fortification with folic acid in the United States is associated with increased expression of DNA methyltransferase-1 in the cervix. Nutrition, 24(1):94-9.
• Hernandez, BY. (2003). Diet and premalignant lesions of the cervix: evidence of a protective role for folate, riboflavin, thiamin, and vitamin B12. Cancer Causes Control, 14(9):859-70.
• http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm