Severe dysplasia (CIN III or SIL high grade or carcinoma in situ) involves the full thickness of the squamous epithelium. Less than one third of CIN 3 dysplasias disappear spontaneously, and about 12 percent eventually progress to cervical cancer.
The Major Cause of Cervical Dysplasia
It is now known that human papilloma virus (HPV), also the cause of genital warts, is the major cause of cervical dysplasia.
Approximately 600,000 American women are diagnosed with cervical dysplasia annually
-- American Medical Association 1999
Risk Factors of Cervical Dysplasia
Many studies have linked the number of sexual partners as a strong risk factor for both pre-invasive and invasive lesions of the cervix. The risk of cervical dysplasia, and cervical neoplasia is higher for women with multiple partners, women who's sexual partners are more promiscuous, and women whose first sexual intercourse was at an early age.
Studies have shown a strong association between cigarette smoking and CIN and invasive cervical cancer.
Most studies have shown a two-fold increased risk for cervical neoplasia among smokers.
Common Nutritional Factors and Cervical Dysplasia
There is good evidence to suggest that some nutrients may have a protective effect against cervical neoplasia, particularly Vitamin A, carotenoids, vitamin C, vitamin E, and folic acid.
Signs and Symptoms
Most frequently patients with cervical dysplasia are asymptomatic. Cervical dysplasia may occasionally be associated with condyloma acuminatum (a small benign wart on or around the genitals and anus) or the presence of sexually transmitted disease such as chlamydia or gonorrhea.
Clinical Lab Assessments
The following laboratory testing can provide value information necessary for diagnosis and treatment. These tests may also give insight to functional metabolism and functional nutrient status in the body.
PAP Smear
This test offers a high probability of identifying cervical dysplasia and should be part of any evaluation of this condition.
Estrogen
The balance of these hormones appears to be important in cervical dysplasia.
Neutrophilic Hypersegmetation Index is a functional test that provides a more accurate determination of a woman's folic acid status and requirements.
Treatment Options
Conventional
Mild dysplasia is often self-limiting. Treatment may be done usually on an outpatient basis, or in the physician's office.
Common Procedures for the Three Stages of Cervical Dysplasia
Increase dietary consumption of folic acid by eating foods like black-eyed peas, chick peas, chicken liver, oranges, brewer's yeast, and spinach. Nutritional Treatment
Folic Acid
Numerous studies report an association between low levels of folic acid and the development of cervical dysplasia.
A deficiency of folic acid causes abnormal cells to develop, especially in areas of the body that have a high rate of cellular turnover, such as the uterine lining in women who are regularly menstruating.
A pilot case-control concluded that low folic acid levels cause a 5-fold increase in the likelihood that a woman may develop cervical dysplasia.
-- University of New Mexico School of Medicine 1992
Birth control pills are known to deplete folic acid, which may contribute to the development of cervical dysplasia. A study reported that oral folic acid supplementation using doses as high as 10 mg daily for 3 months may cause a reversal of this condition.
Vitamin A and Beta-Carotene
A study found that women with lower levels of vitamin A or beta-carotene had a 3-fold greater risk for developing severe cervical dysplasia. In a double-blind study using 141 women already diagnosed with cervical dysplasia, the rate of progression to invasive cervical cancer was 4.5 times higher in women with lower serum retinol levels than those with higher serum retinol levels.
These results suggest that low serum retinol levels also increase the risk of cervical dysplasia developing into cervical cancer.
Direct topical application of the vitamin A derivative trans-retinoic acid may be an effective therapy.
Vitamin C
Women with low intakes of vitamin C were found to have substantially greater risks of developing cervical dysplasia.
Vitamin E
The levels of alpha-tocopherol were found to be significantly reduced in women diagnosed cervical dysplasias or cancer.
Herbal Remedies
Chasteberry
Chasteberry (or also known as vitex) has been recommended for use in mild to moderate complaints, especially in endometriosis, menopause and PMS symptoms.
Studies point to a progesterone-like component and effect. Vitex stimulates luteinizing hormone (LH) and inhibits follicle stimulating hormone (FSH). Because of this activity, vitex has been recommended for a variety of female complaints, such as PMS, cervical dysplasia, dysmenorrhea, amenorrhea, menopausal symptoms, endometriosis and hyperprolactinemia. Several studies have reported beneficial effects of vitex on female-related disorders. Care should be taken if vitex is administered with other hormone replacement products, because breakthrough bleeding or aggravation of complaints could occur.
Bromelain
Bromelain has been used clinically in conditions such as soft tissue inflammation and arthritis, dyspepsia, cervical dysplasia and dysmenorrhea, as well as a digestive aid.
Dr. Grisanti's Comments:
Cervical Dysplasia is a condition that requires careful medical monitoring, however, one should not neglect nutritional management as a powerful step in the treatment and prevention of this disease. The following references strongly support the benefits of using nutritional medicine as a complementary adjunct to the overall clinical management of cervical dysplasia.
References:
Wilkenstein W. Smoking and cervical cancer--current status: A review. Am J Epidemiol. 1990;131:945.
Schneider A, Shah K.The role of vitamins in the etiology of cervical neoplasia: an epidemiological review. Arch Gynecol Obstet. 1989;246(1):1-13.
American Cancer Society. Cervical cancer fact sheet. Revised. Feb2000.
Teaff NL, et al. Cervical dysplasia in the postmenopausal female: diagnosis and treatment. Int J Gynaecol Obstet. Feb1991;34(2):145-9.
La Vecchia C, Decarli A, Fasoli M, Parazzini F, Franceschi S, Gentile A, Negri E. Dietary vitamin A and the risk of intraepithelial and invasive cervical neoplasia. Gynecol Oncol. 1988 Jun;30(2):187-95.
Kanetsky PA, Gammon MD, Mandelblatt J, Zhang ZF, Ramsey E, Wright TC Jr, Thomas L, Matseoane S, Lazaro N, Felton HT, Sachdev RK, Richart RM, Curtin JP. Cigarette smoking and cervical dysplasia among non-Hispanic black women.
Cancer Detect Prev. 1998;22(2):109-19.
Kjellberg L, Hallmans G, Ahren AM, Johansson R, Bergman F, Wadell G, Angstrom T, Dillner J. Smoking, diet, pregnancy and oral contraceptive use as risk factors for cervical intra-epithelial neoplasia in relation to human papillomavirus infection. Br J Cancer. 2000 Apr;82(7):1332-8.
Kwasniewska A, Tukendorf A, Semczuk M. Folate deficiency and cervical intraepithelial neoplasia. Eur J Gynaecol Oncol. 1997;18(6):526-30.
Potischman N, Brinton LA. Nutrition and cervical neoplasia. Cancer Causes Control. 1996 Jan;7(1):113-26. Review. Erratum in: Cancer Causes Control 1996 May;7(3):402.
Butterworth CE Jr, Hatch KD, Macaluso M, Cole P, Sauberlich HE, Soong SJ, Borst M, Baker VV. Folate deficiency and cervical dysplasia. JAMA. 1992 Jan 22-29;267(4):528-33.
Butterworth CE Jr. Effect of folate on cervical cancer. Synergism among risk factors. Ann N Y Acad Sci. Sep1992;669:293-9.
Buckley DI, et al. Dietary micronutrients and cervical dysplasia in southwestern American Indian women. Nutr Cancer. 1992;17(2):179-85.
Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr. Jan1982;35:73-82.
Butterworth CE Jr. Oral folic acid supplementation for cervical dysplasia: a clinical intervention trial. Am J Obstet Gynecol. Mar1992;166(3):803-9.
Zarcone R, Bellini P, Carfora E, Vicinanza G, Raucci F. Folic acid and cervix dysplasia]Minerva Ginecol. 1996 Oct;48(10):397-400
Wylie-Rosett JA, et al. Influence of vitamin A on cervical dysplasia and carcinoma in situ. Nutr Cancer. 1984;6(1):49-57.
Mackerras D, et al. Randomized double-blind trial of beta-carotene and vitamin C in women with minor cervical abnormalities. Br J Cancer. Mar1999;79(9-10):1448-53.
Weiner SA, et al. A phase I trial of topically applied trans-retinoic acid in cervical dysplasia-clinical efficacy. Invest New Drugs. 1986;4(3):241-4.
Liu T. A case control study of nutritional factors and cervical dysplasia. Cancer Epidemiol Biomarkers Prev. Nov1993;2(6):525-30.
View Abstract
Wassertheil-Smoller S, et al. Dietary vitamin C and uterine cervical dysplasia. Am J Epidemiol. Nov1981;114(5):714-24.
Mackerras D, et al. Randomized double-blind trial of beta-carotene and vitamin C in women with minor cervical abnormalities. Br J Cancer. Mar1999;79(9-10):1448-53.
Palan PR, et al. Plasma levels of antioxidant beta-carotene and alpha-tocopherol in uterine cervix dysplasias and cancer. Nutr Cancer. 1991;15(1):13-20.
Amann W. Amenorrhea. Favorable Effect of Agnus castus (Agnolyt) on Amenorrhea. ZFA. Stuttgart. 1982;58(4):228-31.
Sliutz G, et al. Agnus castus Extracts Inhibit Prolactin Secretion of Rat Pituitary Cells. Hormone and Metabolic Research. 1993;25:253-55.
Makwana HG, et al. General Pharmacology of Vitex leucoxylon Linn Leaves. Indian J Physiol Pharmacol. 1994;38(2):95-100.
Milewicz A, et al. Vitex Agnus castus Extract in the Treatment of Luteal Phase Defects Due to Latent Hyperprolactinemia. Results of a Randomized Placebo-controlled Double-blind Study. Arzneim Forsch/Drug Res. 1993;43(7):752-56.
Bhargava SK. Antiandrogenic Effects of a Flavonoid-rich Fraction of Vitex Negundo Seeds: A Histological and Biochemical Study in Dogs. J Ethnopharmacol. 1989;27(3):327-39.
Hillebrand H. The Treatment of Premenstrual Aphthous Ulcerative Stomatitis with Agnolyt. Z Allgemeinmed. 1964;40(36):1577.
Jarry H, et al. In Vitro Prolactin But Not LH and FSH Release Is Inhibited by Compounds in Extracts of Agnus castus: Direct Evidence for a Dopaminergic Principle by the Dopamine Receptor Assay. Exp Clin Endocrinol. 1994;102(6):448-54.
Snow M. Vitex agnus-castus L. (Verbenaceae). Protocol Journal of Botanical Medicine. 1996;1(4):20-23.
Propping D, et al. Diagnosis and Therapy of Corpus Luteum Deficiency in General Practice. Therapiewoche. 1988;38:2992-3001.
Monograph:Bromelain. Altern Med Rev. Aug1998;3(4):302-5.
Blumenthal M, et al, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:33-35.
Kelly G. Bromelain: A literature review and discussion of its therapeutic uses. Alt Med Rev. Nov1996;Vol 1(4):120-23.
Taussig SJ, et al. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update.J Ethnopharmacol. Feb1988;22(2):191-203.
Reviewed and submitted on February 21, 2004
