Introduction:
The cervix is the lower part of the uterus, conical in shape at the lower narrow portion of the uterus which connects to the upper vagina. Cervical cancer may not cause any symptoms initially, but pelvic pain or bleeding from the vagina may occur later. It usually takes several years for normal cells in the cervix to turn into cancer cells. Treatment may include surgery, radiation therapy, chemotherapy, or a combination of these. There has been research showing that nutrients found in carrots, sweet potatoes, spinach, kale, collard greens, papaya, bell peppers, tomatoes, and gooseberry may be associated with a lower risk of cervical cancer.
Cause of cervical cancer:
Infection with the virus called human papillomavirus (HPV) is the cause of almost all cervical cancers. Most adults have been infected with HPV at some time in their lives, but most infections clear up on their own. An HPV infection that doesn’t go away may cause cervical cancer in some women. Human papillomavirus (HPV) is a sexually transmitted virus. HPV types 16 and 18 account for 70% of all cervical cancer and 90% of anal cancer cases. There are 493,000 new cases of cervical cancer and 274,000 related deaths each year. (1)
These statistics are clear evidence for the use of the HPV vaccine and other use of preventive measures such as sexual abstinence, avoidance of multiple partners, and the use of condoms.
Screening for cervical cancer:
Cervical cancer screening with cytology (Pap smear) once every 3 years for women ages 21 to 65 years, or screening with cytology and human papillomavirus (HPV) testing every 5 years for women ages 30 to 65 years is strongly recommended by the U.S. Preventive Services Task Force (USPSTF). The USPSTF recommends against cervical cancer screening in women: a) younger than age 21 years; b) older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer; and c) who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion or cervical cancer. Additionally, in women younger than age 30 years, the USPSTF recommends against screening for cervical cancer with HPV testing, alone or in combination with cytology. (2)
Dietary modifications which may reduce cancer risk according to the National Research Council (3):
Beta-carotene levels and cancer risk: According to the National Research Council, Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids, higher blood concentrations of beta-carotene and other carotenoids vegetable food sources such as in carrots, sweet potatoes, spinach, kale, collard greens, papaya, bell peppers, and tomatoes have been linked to a lower risk of cancer, especially lung, mouth, throat, and cervical cancers. A blood beta-carotene concentration less than 0.28 micromol/L has been linked with a higher risk of several cancers, while a concentration of more than 0.28 to 0.37 micromol/L have been associated with a reduced risk of several cancers in prospective blood concentration studies. However, three other large randomized studies reported no cancer benefit from beta-carotene supplements given at 20, 30, or 50 mg/d for 4 to 12 years. (3)
Best sources of beta-carotene:
Food sources are preferred and beta-carotene supplements are not recommended. The National Research Council, Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids, have stated that beta-carotene supplements are not advised among healthy individuals, unless they suffer from or are at risk of vitamin A deficiency. Beta-carotene supplementation results in a greater increase of beta-carotene blood concentration than beta-carotene rich foods. A 20 mg/d supplement of beta-carotene can result in blood concentrations high enough to increase a patient’s risk of lung cancer, while the same quantity obtained from foods was not associated with lung cancer risk. Additionally, 30 mg/d of beta-carotene supplement was associated with blood concentrations 5 times greater than that of 29 mg/d of beta-carotene from carrots. (3)
Ideal quantity of beta-carotene consumption:
The consumption of 5 or more daily servings of fruits and vegetables is recommended by “National Cancer Institute’s Five-A-Day for a Better Health program” and “Canada’s Food Guide for Healthy Eating.” Eating a variety of 5 fruits and vegetables per day provides the individual with about 5.2 to 6 mg/day of food based beta-carotene (3).
According to Martini et al in the University of Minnesota Cancer Prevention Research Unit Feeding Studies, an intake of 5 mg per day of beta carotene was required to establish beta carotene levels to a plasma level of 0.37 umol/L. When food based beta carotene was consumed in the form of about 1.5 cups of carrots, and about 0.9 cups of spinach which equated to just over 42 mg of beta-carotene per day, levels increased to 0.83 umol/L. (5)
Natural therapy for human papilloma virus (HPV) genital warts:
Green tea extracts applied either as an ointment twice per week (polyphenon E ointment), an oral dose daily (poly E or (-)-epigallocatechin-3-gallate [EGCG]), or as a combination of the ointment and the oral form daily, showed response rates of 74%, 75%, and 50-60% respectively (6). These green tea extract medications are available by prescription.
Phyllanthus emblica (PE), Indian gooseberry:
Scientists tested the anti-cancer effects of phyllanthus emblica (PE), Indian gooseberry known for its medicinal properties. In a series of experiments on mice and on human cancer cell lines, they found that an extract of PE may help slow tumor growth and promote apoptosis (a type of programmed cell death essential for stopping the proliferation of cancer cells). PE extract at 50-100 microg/mL significantly inhibited cell growth of six human cancer cell lines: lung, liver, cervical, breast, ovarian and colorectal. Additionally, researchers saw a 50% reduction of tumor numbers and volumes in mice treated with PE extract. PE extract at 25 and 50 micrograms/mL was also shown to inhibit invasiveness of breast cancer cells. These results suggest PE has anti-cancer properties against certain cancer cells. (4)
Assessment and Plan:
- Infection with the human papillomavirus (HPV) is the cause of almost all cervical cancers (1).
- Consider the use of the HPV vaccine for patients and use of preventive measures such as sexual abstinence, avoidance of multiple partners, and the use of condoms.
- Cervical cancer screening with cytology (Pap smear) once every 3 years for women ages 21 to 65 years, or screening with cytology and human papillomavirus (HPV) testing every 5 years for women ages 30 to 65 years is strongly recommended by the U.S. Preventive Services Task Force (USPSTF) (2).
- A beta-carotene level from fruit and vegetable food sources of more than 0.28 to 0.37 micromol/L have been associated with a reduced risk of lung, mouth, throat, and cervical cancers, and a blood beta-carotene concentration less than 0.28 micromol/L has been linked with a higher risk of several cancers (3). Beta-carotene supplements may increase the risk of lung cancer and are not recommended. (3)
- An intake of a variety of 5 fruits and vegetables daily provides the individual with about 5.2 to 6 mg/day of food based beta-carotene (3). According to Martini et al in the University of Minnesota Cancer Prevention Research Unit Feeding Studies, an intake of 5 mg per day of beta carotene was required to establish beta carotene levels to a plasma level of 0.37 umol/L (5).
- Natural therapy for human papilloma virus (HPV) lesions: Green tea extracts applied either as an ointment twice per week (polyphenon E ointment), an oral dose daily (poly E or (-)-epigallocatechin-3-gallate [EGCG]), or as a combination of the ointment and the oral form daily, showed response rates of 74%, 75%, and 50-60% respectively (6). These green tea extract medications are available by prescription.
References:
1.Altinbas SK, Tapisiz OL. Human papillomavirus, vaccines, and protection from cervical cancer. Saudi Med J. 2012 Dec;33(12):1270-7. http://www.ncbi.nlm.nih.gov/pubmed/23232673
2.Screening for Cervical Cancer, Topic Page. April 2012. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm
3.Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids : a report of the Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. Washington, D.C. : National Academy Press, c2000. http://www.ncbi.nlm.nih.gov/nlmcatalog/100938980
4.Ngamkitidechakul C, Jaijoy K, Hansakul P, Soonthornchareonnon N, Sireeratawong S. Antitumour effects of Phyllanthus emblica L.: induction of cancer cell apoptosis and inhibition of in vivo tumour promotion and in vitro invasion of human cancer cells. Phytother Res. 2010 Sep;24(9):1405-13. http://www.ncbi.nlm.nih.gov/pubmed/20812284
5.Martini MC, Campbell DR, Gross MD, Grandits GA, Potter JD, Slavin JL. Plasma carotenoids as biomarkers of vegetable intake: the University of Minnesota Cancer Prevention Research Unit Feeding Studies. Cancer Epidemiol Biomarkers Prev. 1995 Jul-Aug;4(5):491-6. http://www.ncbi.nlm.nih.gov/pubmed/7549804
6.Ahn WS, Yoo J, Huh SW, Kim CK, Lee JM, Namkoong SE, Bae SM, Lee IP. Protective effects of green tea extracts (polyphenon E and EGCG) on human cervical lesions. Eur J Cancer Prev. 2003 Oct;12(5):383-90. http://www.ncbi.nlm.nih.gov/pubmed/14512803