Cervical Dysplasia

Getting Your Cells in Line

It gets scraped during a Pap test, bumped during intercourse, stretched open during childbirth and occasionally covered with latex or squirted with foam when you’re trying to avoid pregnancy. But other than that, your cervix is not really a focal point of your life. Out of sight, out of mind, right?

Right. Until your gynecologist says that something is wrong.

For somewhere between 250,000 and 1 million women every year, that something is cervical dysplasia, a condition in which cells lining the cervix stop organizing themselves into nice, neat, horizontal layers that reflect their maturity from youngest to oldest.

Instead, a few older cells apparently decide to hang out with the younger crowd, then become disruptive when their increasing growth no longer allows them to neatly fit in among their younger siblings. They push the other cells around, which eventually disrupts the rows.

Fortunately, the fact that these cells are out of line signals itself on a Pap test. Depending on how many of these juvenile delinquents there are, a lab technician will label the test either “low-grade squamous intraepithelial lesion” for the minor disruptions of mild dysplasia or “high-grade squamous intraepithelial lesion” for the more significant disruptions of moderate and severe dysplasia. Carcinoma in situ, which is also a high-grade squamous intraepithelial lesion, is not a form of cancer, despite its name. Dysplasia becomes cancer when the delinquent cells quit jostling their brothers and sisters and invade the cervix itself.

And that, of course, is what most women who find out they have cervical dysplasia are afraid of. Although not all dysplasia progresses to cervical cancer, most doctors surgically remove or otherwise destroy the cells involved because they feel that dysplasia is the first step down the road to cancer.

But that thinking is beginning to change.

“Researchers are studying both the progression of cervical dysplasia toward cancer and its regression back to the normal state (which is far more common),” says Nancy Potischman, Ph.D., a senior staff fellow at the National Cancer Institute in Rockville, Maryland. So instead of just asking themselves “Why are these cervical changes evolving into cancer?” researchers are also asking “What blocks the cervix’s return to normal?”

“Human papillomavirus (HPV), in combination with other genetic and environmental factors such as cigarette smoke, is believed to be the main cause of cervical cancer,” says Dr. Potischman. But there may also be nutritional factors that affect whether dysplastic cells return to normal. Based on what she has seen so far, says Dr. Potischman, “it may be that vitamin C, vitamin E, beta-carotene and other carotenoids play parts in whether your cervix returns to normal.”

What vitamins C and E and beta-carotene have in common is that they enhance immune function. They are also antioxidants, which means that they protect your body’s healthy molecules by neutralizing naturally occurring unstable molecules called free radicals, which cause cellular damage by stealing electrons to balance themselves.

Antioxidant Power

Evidence that antioxidant vitamins can reverse dysplasia is impressive.

In a study at Albert Einstein College of Medicine in New York City, for example, researchers took blood samples from 43 women with cervical dysplasia and compared them with blood samples taken from women who did not have the condition. The comparison revealed that lower levels of beta-carotene and vitamin E corresponded to a significantly increased risk of cervical dysplasia.

And what really knocked the socks off the researchers was a direct correlation between the amounts of beta-carotene and vitamin E in the blood and the stage of cervical abnormality.

In other words, says study leader Prabhudas R. Palan, Ph.D., assistant professor of obstetrics and gynecology at Albert Einstein, the less beta-carotene and vitamin E in a blood sample, the more dysplasia in the cervix.

An older study of vitamin C, also done at Albert Einstein, showed similar results. In that study, researchers figured out the amount of vitamin C in the diets of 87 women with dysplasia, then compared it with the amount of vitamin C in the diets of women without dysplasia. They found that women who consumed less than 30 milligrams of vitamin C a day were ten times more likely to develop dysplasia than women who consumed more.

But will increasing your intake of antioxidants help heal dysplasia?

Perhaps, says Dr. Palan, who is conducting a study to find out. In this study, women with the condition are being given 30 milligrams (about 50,000 international units) of pure beta-carotene every day for nine months.

In any event, the signs are good, since other studies have already demonstrated that a diet rich in beta-carotene, vitamin C and vitamin E can prevent cervical cancer.

In a study in four Latin American countries of 748 women with cervical cancer, for example, researchers found that women who got more than 300 milligrams of vitamin C and 6,000 micrograms (about 10,000 international units) of beta-carotene a day from fruits and fruit juices were roughly 30 percent less likely to develop cervical cancer than women who got less of these nutrients.

How beta-carotene, vitamin C and vitamin E might keep cervical dysplasia in check is still unknown, says Dr. Palan. Some researchers suspect that these nutrients enhance the ability of your immune system to fight off attackers such as HPV, which is known to increase your risk of dysplasia. Others feel that the nutrients work by increasing the amount of vitamin A available to your cells.

“We’ve found that the antioxidant properties are important,” says Dr. Palan.

Depending on supplements alone is not the best way to guard against cervical dysplasia, says Dr. Palan. That’s because the fresh fruits and vegetables rich in cervix-protecting vitamins, particularly beta-carotene, may contain other beneficial substances.

But supplements can provide added benefits to a diet that already gets five servings of fruits and vegetables a day. Many nutrition experts do recommend taking daily supplements that include 50,000 international units of beta-carotene, 500 milligrams of vitamin C and 100 international units of vitamin E.

Folic Acid Fixes

Although antioxidants such as beta-carotene, vitamin C and vitamin E clearly play pivotal roles in protecting your cervix from dysplasia, folate (the naturally occurring form of folic acid) may actually be more important.

Researchers have been studying the effects of folate on cervical dysplasia for years, yet the relationship between folate levels and dysplasia is so complex that study results have been equivocal. Some studies indicated that a low level of folate in the body increases the risk of dysplasia; others indicated that it doesn’t.

But researchers have begun to suspect that these inconsistencies, frustrating as they may be, are the smoking gun that is actually pointing them in the right direction. So instead of looking just at how many women with low levels of folate have dysplasia versus how many women with high levels of folate have the condition, researchers are looking at the relationship between folate levels and risk factors such as smoking, oral contraceptives, pregnancy and HPV infection. All of these things are known to be associated with dysplasia.

In a study at the University of Alabama in Birmingham, researchers compared the amount of folate in the red blood cells of 294 women with cervical dysplasia with that of women without the condition. Then they checked with the women to see whether they smoked, used oral contraceptives, had given birth or had an HPV infection. And in each case, they found that the risk factor was more likely to be associated with dysplasia if the women had low levels of folate. Women with low levels of folate who were infected with HPV, for example, were five times more likely to develop dysplasia than women who were loaded with folate.

“Micronutrients such as folate are involved in nucleic acid synthesis and repair. And folate deficiency is a cause of chromosomal breaks,” explains Tom Becker, M.D., associate professor of medicine at the University of New Mexico in Albuquerque, who is studying the nutrient. It’s possible that cervical cells that have had DNA damage related to low folate levels could be further damaged by cigarette smoke by-products or an HPV infection, could become dysplastic and may not be able to repair themselves. As a result, they may very well be blocked from returning to normal and instead progress to cervical cancer.

Given that possibility, it may be more risky to be low in folate than to be low in antioxidants, says Dr. Becker. “Research suggests that a diet with plenty of cereals, fruits and green, leafy vegetables, as well as orange and red vegetables, will help prevent cervical dysplasia,” he said. So there’s yet another reason to learn to love those colorful veggies.

The recommended Daily Value for folic acid is 400 micrograms a day, although pregnant women should get up to twice that amount. Unfortunately, most American women get only about 236 micrograms a day.