FAQ #13: How do naturopathic doctors help prevent and treat cervical .... Vitamin C. 13,14. ⢠Green tea extract. 15. â
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FAQ #13: How do naturopathic doctors help prevent and treat cervical dysplasia and Human Papillomavirus (HPV)?
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The main risk factor for cervical dysplasia is the presence of HPV. Approximately 40 percent of American women (and 45 percent of men) currently have some form of HPV.
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Without treatment, advanced cervical dysplasia can progress to cervical cancer.
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Naturopathic doctors who specialize in women’s health offer both preventive education and natural treatments for dysplasia and HPV.
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NDs emphasize safe sex, smoking cessation and optimizing nutrition for prevention of dysplasia.
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NDs offer natural therapies to treat dysplasia and HPV directly, and to help the body’s immune system fight the virus.
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NDs treat low- and mid-grade dysplasia with a combination of lifestyle modification, therapeutic diets, nutrient and botanical therapies, and local treatment of the cervix.
Cervical dysplasia refers to pre-cancerous changes in the cells on the surface of the cervix. While dysplasia can be caused by a number of factors, one common cause is the presence of one of the strains of Human Papilloma Virus, or HPV. Often times, the body will heal an HPV infection on its own and cervical cells go back to normal as the infection clears. In some cases, however, the grade of cervical dysplasia can worsen. Without treatment, advanced cervical dysplasia can progress to cervical cancer. In the U.S., Pap Smears have cut the incidence of cervical cancer in half over the past 40 years due to early detection. But approximately 40 percent of American women (and 45 percent of men) currently have some form of HPV, putting them at risk.
Focusing on the whole person, naturopathic doctors take the time to identify and address the genetic, environmental, and behavioral/lifestyle factors that cause cervical dysplasia. Naturopathic doctors who specialize in women’s health offer you and your sexual partner both preventive education and natural treatments for dysplasia and HPV. Naturopathic doctors focus on the least invasive, most natural, effective treatments first, and partner with conventionally trained specialists if surgical interventions are needed. Risk Factors The main risk factor for cervical dysplasia is the presence of HPV. Other risk factors include: • • • • • • • • • • •
Multiple sexual partners Young age at first intercourse (5 years) Low socioeconomic status
Screenings and Prevention
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Naturopathic doctors follow the American College of Obstetricians and Gynecologists (ACOG) guidelines for dysplasia and HPV screenings in women 21-65 years old, utilizing the Pap Smear and HPV tests. Additionally, naturopathic doctors recommend and perform screenings for HPV and dysplasia in the mouth, throat, and anus, where the virus can also be spread through contact with sexual partners.2,3 Patients who have an abnormal result or test positive for HPV are advised to have their sexual partners also be tested and treated, to prevent further transmission. Naturopathic doctors emphasize these important preventive measures: •
Practicing safe sex. Safe sex decreases transmission of HPV, HIV, and other sexually transmitted diseases.
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Smoking cessation. Smoking is linked to cervical cancer as it increases the duration of infection with high risk HPV.4 Smoking also weakens the immune system.
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Optimizing nutrition. Poor nutritional status is linked to cervical cancer. Folate and B12 deficiencies have been associated with increased HPV infection.5 Low serum retinol levels have been linked to increased risk of dysplasia.6 Naturopathic doctors have advanced training in nutrition and will provide a comprehensive nutritional intake and individualized dietary counseling to address nutritional deficiencies.
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HPV vaccination can reduce the risk of infection by the HPV types targeted by the vaccine. Because none of the currently available HPV vaccines protect against all HPV infections, it is important for vaccinated women to continue to undergo cervical cancer screening. Diagnosis
If you are diagnosed with cervical dysplasia and/or HPV after your Pap Smear and HPV test, your naturopathic doctor may refer you for a colposcopy, a procedure which uses a special magnifying instrument (colposcope) to determine the extent and degree of dysplasia. Dysplasia is then categorized as cervical intraepithelial neoplasia (CIN), and graded level I (lower grade change in cervical cells), II, or III (highest grade change). Treatment Depending on your diagnosis, conventionally trained doctors often suggest one or more of four treatment approaches for dysplasia: 1) “watch and wait” and repeat the Pap Smear every 3 to 6 months, 2) cryoptherapy to freeze abnormal cells, 3) loop electrosurgical excision procedure (LEEP), which uses electricity to remove affected tissue, and/or 4) cone biopsy, to remove the affected portion of the cervix. Risks and complications of surgical procedures can include scar tissue, prolonged bleeding, and infection. These complications can have longer term effects on conception and childbirth.7 Additionally, these treatments may not
on conception and childbirth.7 Additionally, these treatments may not address the underlying cause of the cervical dysplasia, which is the HPV infection.
The AANP and the INM would like to acknowledge Marianne Marchese, ND for her contributions to the content of this FAQ. Some of the content first appeared in an article by Dr. Marchese on the AANP website, and in an article by Ellen Lewis, ND on her website.
Naturopathic doctors offer natural therapies to treat dysplasia and HPV directly, and to help the body’s immune system fight the virus. In doing so, naturopathic doctors may reverse low-grade cervical cell abnormality and eliminate HPV. Naturopathic doctors treat low- and mid-grade dysplasia with a combination of lifestyle modification, therapeutic diets, nutrient and botanical therapies, and local treatment of the cervix. Specific therapies are individualized to the patient based on their diagnosis, emotional, and physical constitution. Nutrient and botanical therapies may include: • • • • • • • •
Folic acid8 Indole-3-carbinol9,10 Antioxidants11,12 Vitamin C13,14 Green tea extract15 Coriolus versicolor16 Curcumin17 Methyl B1218
Local cervical treatments may include: •
Vaginal suppositories consisting of green tea and/or curcumin, which draw infection out of the cervical cells and boost the immune system.19,20
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Escharotic treatment, which uses natural enzymes and herbal solutions to remove abnormal, damaged tissue and stimulate the regrowth of normal tissue. This treatment is performed two times per week for approximately six weeks.21,22
Thousands of patients have safely benefited from this treatment, but larger clinical studies are needed. It is important to have a comprehensive diagnosis and consider all of your options for managing cervical health. There are times natural medicine is not an option for treating cervical cell changes due to the severity and location of disease. In many cases, however, naturopathic treatment of cervical dysplasia and HPV is a safe and effective option. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22.
Tolstrup, J, Munk, C, Thomsen, B, et al. The role of smoking and alcohol intake in the development of high-grade squamous intraepithelial lesions among high-risk HPV-positive women. National Center for Biotechnology Information. 2006. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16929418. Accessed April 15, 2015. http://www.mountsinai.org/patient-care/service-areas/ent/areas-of-care/head-and-neck-cancer/oral-cancer/hpv/hpv-faq J Oral Pathol Med. 2015 Jan;; 44(1): 28-36 Synder U. A look at cervical cancer. Medscape OB/GYN & Women’s Health. 2003;;8(1):1-12 Weinstein SJ, et al. Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer. J Nutr. 2001;;131:2040-2048. Schiff MA, et al. Serum carotenoids and risk of cervical epithelial neoplasia in southwestern American women. Cancer Epidemiol Biomarkers Prev. 2001;;10:1219-1222. Int J Gynaecol Obstet. 2016 Mar;;132(3):266-71. doi: 10.1016/j.ijgo.2015.07.026. Epub 2015 Nov 28. Marshall K. Cervical dysplasia: early intervention. Altern Med Rev. 2003;;8(2):156-70. Grubbs CJ, Steele VE, Casebolt T, et al. Chemoprevention of chemically-induced mammary carcinogenesis by indole-3-carbinol. Anticancer Res 1995;;15:709-716. Bell MC, Crowley-Nowick P, Bradlow HL, et al. Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecol Oncol 2000;;78:123-129. Palan PR, Mikhail MS, Basu J, Romney SL. Plasma levels of antioxidant beta-carotene and alpha-tocopherol in uterine cervix dysplasia and cancer. Nutr Cancer 1991;;15:13-20. Mikhail MS, Palan PR, Romney SL. Coenzyme Q0 and alpha tocopherol concentrations in cervical intraepithelial neoplasia and cervix cancer. Obstet Gynecol 2001;;97:3S. Ghosh C, et al. Dietary intakes of selected nutrients and food groups and risk of cervical cancer. Nutr Cancer. 2008;;60(3):331-41. Lee Gj, et al. Antioxidant vitamins and lipid peroxidation in patients with cervical intraepithelial neoplasia. J Korean Med Sci. 2005 Apr;;20(2):267-72. Ahn ws, et al. The protective effects of green tea extract on human cervical lesions. Eur J cancer prev2003;;12(5):383-390 Bogdanova J. [Coriolus versicolor--innovation in prevention of oncogynecological diseases, especially HPV]. Akush Ginekol (Sofiia). 2008;;47 Suppl 3:51-3. Mishra A., Kumar R., Kohaar, Curcumin Modulates Cellular AP-1, NF-kB, and HPV16 E6 Proteins in Oral Cancer. Ecancermedicalsciene 9, 525 (2015). Piyathilake CJ, Cancer Prev Res (Phila). 2014 Nov;; 7(100): 1128-1137. Int J Gynecol Cancer. 2010;; 20(4): 617-624 Gattoc L. et al, Open Access J Clin Trials. 2017;;9:1-10. doi: 10.2147/OAJCT.S105010. Epub 2016 Dec 22.Nov Windstar, K., Dunlap, C., Zwickey H. Escharotic Treatment for ECC-positive CIN3 in Childbearing Years: A Case Report. Integr Med (Encinitas). 2014 Apr;;13(2):43-9. Swanick, S., Windstar-Hamlin K., Zwickey H., An alternative treatment for cervical intraepithelial neoplasia II, III. Integr Cancer Ther. 2009 Jun;;8(2):164-7. doi: 10.1177/1534735409335504.
