My 29-year-old niece has just been diagnosed with cervical dysplasia-CIN 1-after having a colposcopy, and is extremely worried and confused. She's been advised to go for a repeat colposcopy in six months to see whether treatment is necessary and, as you can imagine, this is making her very anxious. Can you provide us with some information on the condition and whether there's a possibility of treating the problem naturally?
M.D., via email
Cervical dysplasia is a scary diagnosis to get, but it doesn't mean you have cancer. It's the term doctors use for abnormal changes in the cells lining the inner surface of the cervix, the lowest portion of the womb.
These changes are not cancer-and usually have no symptoms-but they are considered 'precancerous', which means that doctors believe they could potentially become cancer if left untreated.
The chances of cervical dysplasia-also known as 'cervical intraepithelial neoplasia' (CIN)-progressing to invasive cancer depends on the severity of the cell abnormality (how much of the epithelium is affected). Research on the natural course of CIN suggests that mild dysplasia, or CIN 1-what your niece has been diagnosed with-will progress to cancer just 1 per cent of the time, whereas moderate (CIN 2) and severe (CIN 3) grades of dysplasia will become cancerous about 5 per cent and 12 per cent of the time, respectively.
In a significant number of cases, the abnormal cells change back to normal on their own. In cases of CIN 1, the proportion is 60 per cent whereas, with CIN 2, it's around 40 per cent and, with CIN 3, it's just over 30 per cent. The rest of the time, the dysplasia is more likely to simply stay as it is rather than progress to a more severe form or to cancer.1
So your niece may be reassured that the changes in her cervix have an extremely low risk of progressing to cancer, and a very high chance of just going away on their own without treatment. And that's why her gynaecologist or colposcopist has taken a 'wait-and-see' approach. If the repeat colposcopy (a procedure that closely examines the cervical cell lining using a magnifying instrument called a colposcope) reveals that the changes have got worse, then treatment may be recommended to remove the abnormal cells.
Usually, doctors recommend treatment for cases of moderate-to-severe dysplasia and persistent cases of mild dysplasia. Treatments vary, depending on the grade of cell abnormality, but all
are invasive and all come with both short- and long-term risks.
Large loop excision of the transformation zone (LLETZ),or loop electrosurgical excision (LEEP) as it's known in the US, uses a thin wire loop heated with an electrical current to cut away the areas of the cell lining that are abnormal.
It's the most common treatment for CIN in the UK and is said to have a 90-95 per cent cure rate. Risks include bleeding, infection and problems during pregnancy such as having a preterm or low-birth-weight baby.
Cone biopsyis when a cone-shaped wedge of abnormal tissue is surgically removed from the cervix. It's reported to have a cure rate of 70-98 per cent. The risks are similar to those with LLETZ, but it's also been linked to perinatal death in babies born to mothers who had the procedure.2 If general anaesthesia is required, there are further risks associated with that too.
Cryotherapyuses a cold probe to freeze away the abnormal cells. It's said to destroy 99 per cent of the abnormal tissue. Risks include bleeding, infection and scarring, and it's also been linked to higher rates of subsequent cervical cancer compared with other treatments.3
Laser vaporization therapyuses a laser to pinpoint and burn away the abnormal cells, and comes with a 90 per cent cure rate. There may be less scarring than with cryotherapy, but there's often more pain and bleeding.4
To boost the chances of your niece's cervical dysplasia reverting to normal and to avoid her having to consider any of the above procedures in future, she could look into the dietary and lifestyle factors associated with cervical dysplasia. Almost all cases are thought to be due to the tumour-causing types of sexually transmitted human papillomavirus (HPV), some strains of which are associated with cervical cancer. But not all women with these viruses develop cervical dysplasia or cervical cancer, so other factors to do with the individual are likely to be involved.
In fact, a growing body of evidence suggests it may be possible to reverse these abnormal cell changes naturally, so check out the options below and consider seeking the help of an experienced naturopathic practitioner who can suggest appropriate dosages and a fully holistic approach.
Try folic acid
Low levels of certain nutrients and particularly folate (vitamin B9) have been linked to cervical dysplasia, possibly because such a state leaves the body poorly equipped to fight off a viral attack. In one study of more than 500 women with and without CIN, researchers reported significantly lower levels of folate in those with CIN and HPV infection compared with those who had normal smear-test results. They also found that having low levels of antioxidants such as vitamins C, E and A together with low folate levels increased the risk of developing CIN.5
Another study found that women with low blood folate levels (at or below 660 nmol/L) were five times more likely to be infected with HPV 16-one of the more aggressive forms of the virus that is strongly associated with grade CIN 3 and cervical cancer.6
It makes sense that not having enough folate is implicated in cervical dysplasia, as the vitamin is crucial for the formation and repair of DNA. As the cells of the cervical lining replace themselves every 7-14 days, they are constantly making DNA, giving the HPV genetic material numerous opportunities to incorporate itself into the host DNA. When folate levels are low, DNA becomes even more susceptible, so increasing the risk of attack by carcinogens and viruses.7
It's not yet clear whether supplementing with folic acid, the man-made form of folate, can reverse cervical dysplasia. In one trial, 10 mg/day of folic acid showed no significant effects in women with CIN 1 or 2.8 Yet, in another trial of women with CIN 1 or 2 taking oral contraceptives, those taking folic acid supplements (again at 10 mg/day) for three months had significantly better biopsy scores by the end of the study, and their CIN grade levels also improved.9 It may be that women taking oral contraceptives respond better to folic acid supplements, as the Pill is known to deplete levels of folate in the body.
Although more research is needed on the potential of folic acid to help cervical dysplasia, taking the supplement seems safe (your niece could try a dose of up to 5 mg daily in combination with other B vitamins, especially B6 and B12), and may be worth considering as an aid to improving cell abnormalities and reducing the risk of cervical cancer.
Low levels of these antioxidant pigments found in fruit and vegetables have been linked to CIN as well as cervical cancer. In one study, blood levels of the carotenoids beta-carotene, lycopene and canthaxanthin were significantly lower in women with CIN or cervical cancer compared with women without those conditions.10 Similarly, low levels of alpha-carotene, zeaxanthin and lutein have also been associated with an increased risk of CIN, although a trial of beta-carotene supplementation reported that 30 mg/day was not enough to improve high-grade CIN.11 But supplementing may be worth a try in your niece's much milder case.
Opt for A
One study showed that women with cervical dysplasia and low vitamin A intakes and low levels of retinol in the blood are nearly five times more likely to have their CIN progress to its most severe form or even invasive cancer,12 while studies of the use of topical vitamin A to treat CIN have been promising. In one such study, which used a collagen sponge insert and a cervical cap to deliver vitamin A (in the form of all-trans retinoic acid) directly into the cervix, a short course of treatment appeared to enhance the regression of CIN 2. In the retinoic-acid group, 43 per cent of those with CIN 2 were back to normal after six months compared with only 27 per cent of those taking a placebo, although again there was no effect in the more severe CIN-3 patients.13
As vitamin A can be toxic in high amounts, your niece should try this approach only with the guidance of a qualified practitioner.
If your niece is a smoker, now's a good time for her to quit. Smoking is associated with a higher risk of HPV infection as well as CIN and cervical cancer. In fact, the International Agency for Research on Cancer (IARC) has listed cervical cancer among the conditions caused by smoking.14 And even passive smoking can cause cervical cell abnormalities, according to a recent study.15
Ditch the Pill
More controversial is the idea that oral contraceptives could be contributing to CIN and cervical cancer. While your doctor may tell you there's no evidence of a connection, a recent meta-analysis pooling the results of 28 separate studies found that, compared with women who have never used oral contraceptives, Pill users have a significantly higher risk of cervical cancer, and the risk increases the longer they've been using it.16 As already mentioned, oral contraceptives have been linked to folate deficiency,17 which might explain the link between these drugs and cervical dysplasia.
Relaxation techniques and mind-body therapies like yoga and tai chi may be helpful. Research has revealed a significant association between levels of perceived stress and the immune response to HPV in women with cervical dysplasia. Those who reported feeling more stressed were more likely to have an impaired immune response to HPV in particular, making them unable to fight off the virus effectively.18
Go for green tea
Green tea extracts used as either a topically applied ointment or a capsule taken by mouth are showing promise as a treatment for cervical dysplasia and HPV infection. A Korean study of 51 women found that 69 per cent of those treated with green tea improved compared with just 10 per cent in the untreated group.19
Indole-3-carbinol (I3C), found naturally in cruciferous vegetables like cabbage, broccoli and Brussels sprouts, can help. In a trial of 30 patients with CIN 2/3, some took 200 mg/day of I3C and others took 400 mg/day of I3C, while a third group were taking a placebo. After 12 weeks, biopsies were done to see if there were any changes. None of the 10 patients in the placebo group saw complete regression of their CIN, whereas four of the eight patients in the 200 mg/day arm and four of the nine in the 400 mg/day arm had complete regression of their dysplasia.20
Suggested dosage: 200 mg/day
If the abnormal cells persist or progress, your niece may wish to consider escharotic treatment, based on a centuries-old principle of using certain plant and mineral extracts to treat
skin lesions. Traditionally, zinc chloride and Sanguinaria canadensis (bloodroot) are part of the recipe, which may also include bromelain and Calendula succus, made from the freshly pressed juice of marigold flowers. These preparations can be applied to the cervix directly or taken orally and work by dissolving the uppermost layer of cervical cells. This natural alternative has shown promise in the treatment of cervical dysplasia.7, 21 Consult an experienced naturopath to find out more.