Abnormal Cervical Cells-Should I Be Worried?

Cervical dysplasia is when there are abnormal or precancerous cells in and around a woman’s cervix. Cervical dysplasia is detected by a pap smear. Abnormal changes in cells can be either mild, moderate, or severe. Having cervical dysplasia does not mean that you have cervical cancer. If abnormal cells are detected in a pap-smear then a biopsy may be completed to determine the extent of the dysplasia. Cervical dysplasia that is found on a biopsy is called cervical intraepithelial neoplasia (CIN). There are three possible stages of CIN.

Stages:
CIN1- mild dysplasia
CIN2- moderate to marked dysplasia
CIN3- pre-invasive precursor with a potential to progress to cancer1

There are several risk factors in developing CIN. Human Papilloma virus accounts for over 90% of all cervical changes. 2 HPV infection is necessary for cervical cancer but does not necessarily mean HPV will progress to cervical cancer. There are two main HPV strands, 16 and 18, that are associated with persistent HPV infection with a greater risk of developing cervical cancer.

Risk factors for acquiring HPV can be divided into two categories:

• Early onset of sexual activity
• Multiple sexual partners
• A high-risk sexual partner
• History of STI- chlamydia
• Early age at first birth
• History of vulvar or vaginal squamous intraepithelial neoplasia or cancer
• Weakened immune system

• Socioeconomic status
• Long-term use of Oral contraceptives
• Cigarette smoking
• Genetics
• Diet low in fruits and vegetables3

The American Cancer Society updated cervical cancer screening guidelines in 2020, effectively making the biggest change for women ages 21-24.⁴ Within this age bracket, HPV screening is no longer recommended. There are four categories of women considered in the newer guidelines. These categories are divided into the following age groups: ages 21-24; ages 25-29; ages 30-65; ages 65 and older. HPV screening is recommended to begin between ages 25-29 and repeated only every five years with a previous normal test. HPV screening can be discontinued at age 65. Alternatively, a Pap test every three years is considered acceptable; however, HPV testing has been shown to be more reliable.⁴

The Canadian task force and preventative health care have established similar guidelines for screening for cervical cancer. The Canadian guidelines go even further with women from ages 26-29 having a weak recommendation for cervical cancer screening. Women over 30 are recommended to be screened every 3 years. For women over 70 who have participated in routine screening, their screening can end. If women over 70 have not participated in routine screening, they can finish screening after 3 subsequent negative tests. ⁵

A systematic and meta-analysis review of over 3000 women who were identified with CIN were tracked for two years. What was discovered in this study was that over half (50%) of untreated CIN2 lesions spontaneously reversed and one in five women (18%) progressed to CIN3 or worse within these two years. ¹ The spontaneous remission rates were even higher for women that were less than 30 years old (60% and 11% respectively). ¹

Other studies have shown that an HPV infection may take upwards of 10 years to cause precancerous or cancerous lesions. ⁶ Many women under 30 will naturally clear an HPV infection with only the few strands causing persistent infection.  Active surveillance of CIN2 rather than immediate intervention is recommended, especially among younger women.  ⁶ This could be especially important for women of reproductive age because local treatments can be harmful for future pregnancies ¹

The three common treatment options are:

• Cryosurgery to freeze off the abnormal cervical tissue
• LEEP (loop electrosurgical excision procedure) to burn off the abnormal cells with an electric loop
• Surgery to remove the abnormal cells with a laser, scalpel or both

The harms of early screening procedures include an increase in preterm births, premature rupture of membranes, and chorioamnionitis. All very good reasons to consider active surveillance in cases of HPV.4

Numerous studies have shown the benefits of lifestyle factors in the prevention of cervical dysplasia. Exercise and a BMI less than 25 kg/m(2) have been shown to decrease the incidence of cervical dysplasia. 7 Nutrition is another key factor when considering the reduction of HPV infections. High antioxidant diets, consisting of high intakes of fruits and vegetables, improves homocysteine and other markers of oxidative stress. This high consumption was associated with a 54% decrease risk of HPV persistence. 8 Just one papaya a week was shown to positively impact persistent HPV infection. 9 Quitting smoking also provides improved outcomes.

Not surprisingly, the opposite is also true, a western diet was linked to higher risk of HPV infection in women. 10 Individuals with lower vegetables and fruit consumption showed a higher viral load. 11

The take home message is women under the age of 29 may not require treatment but dietary and lifestyle changes can likely help viral clearance and reduce progression of CIN. Women over 30 have a high chance of regression over 2 years with no treatment.

A limited number of supplements have also been researched, mostly in small studies, and found to help HPV regression while promoting healthy cervical cells. If you are experiencing cervical dysplasia, an experienced ND can provide additional support and treatment with all these interventions in mind.

1. Tainio K, Athanasiou A, Tikkinen KAO, et al. Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ. 2018;360:k499. doi:10.1136/bmj.k499
2. Human papillomavirus (HPV) and cervical cancer. Accessed March 11, 2021. https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer
3. Cervical Cancer Risk Factors | Risk Factors for Cervical Cancer. Accessed March 11, 2021. https://www.cancer.org/cancer/cervical-cancer/causes-risks-prevention/risk-factors.html
4. New ACS Cervical Cancer Screening Guideline – National Cancer Institute. Published September 18, 2020. Accessed September 10, 2021. https://www.cancer.gov/news-events/cancer-currents-blog/2020/cervical-cancer-screening-hpv-test-guideline
5. Care CTF on PH. Recommendations on screening for cervical cancer. CMAJ. 2013;185(1):35-45. doi:10.1503/cmaj.121505
6. Popadiuk C, Decker K, Gauvreau C. Starting cervical cancer screening at 25 years of age: the time has come. CMAJ Can Med Assoc J. 2019;191(1):E1-E2. doi:10.1503/cmaj.181312
7. Lee JK, So KA, Piyathilake CJ, Kim MK. Mild Obesity, Physical Activity, Calorie Intake, and the Risks of Cervical Intraepithelial Neoplasia and Cervical Cancer. PLOS ONE. 2013;8(6):e66555. doi:10.1371/journal.pone.0066555
8. Barchitta M, Maugeri A, La Mastra C, et al. Dietary Antioxidant Intake and Human Papillomavirus Infection: Evidence from a Cross-Sectional Study in Italy. Nutrients. 2020;12(5). doi:10.3390/nu12051384
9. Giuliano AR, Siegel EM, Roe DJ, et al. Dietary Intake and Risk of Persistent Human Papillomavirus (HPV) Infection: The Ludwig-McGill HPV Natural History Study. J Infect Dis. 2003;188(10):1508-1516. doi:10.1086/379197
10. Barchitta M, Maugeri A, Quattrocchi A, Agrifoglio O, Scalisi A, Agodi A. The Association of Dietary Patterns with High-Risk Human Papillomavirus Infection and Cervical Cancer: A Cross-Sectional Study in Italy. Nutrients. 2018;10(4):469. doi:10.3390/nu10040469
11. Hwang JH, Lee JK, Kim TJ, Kim MK. The association between fruit and vegetable consumption and HPV viral load in high-risk HPV-positive women with cervical intraepithelial neoplasia. Cancer Causes Control. 2010;21(1):51-59. doi:10.1007/s10552-009-9433-9