Cervical dysplasia: early intervention - Cervical Dysplasia

Alternative Medicine Review, May, 2003 by Keri Marshall

The prevalence of HPV has steadily risen over the past few decades. In the United States, the Centers for Disease Control documented a 459-percent rise in the number of visits to private clinics for condyloma acuminata, a genital lesion caused by HPV, between 1966 and 1981. (20) That number continues to rise. Based on data from a cohort of 22-year-old Finnish women, an estimated 79 percent of Finnish women between the ages of 20 and 79 will contract at least one HPV infection. (21)

Certain HPV types are associated with certain types of disease, although a given HPV type can cause a range of diseases. HPV are double-stranded DNA viruses of approximately 8,000 base pairs. Over 60 types of HPV have been identified. HPV types 6 and 11 are considered low risk and are commonly associated with condyloma acuminata of the lower genital tract and flat cervical condyloma. The medium risk groups, HPV types 33, 35, 39, 40, 43, 45, 51-56, and 58, are associated with low-grade genital dysplasia and carcinomas. The high-risk group of HPV types 16, 18, and 31 are associated with CIN III and malignant neoplasia of the penis, cervix, vulva, and perineum (Table 2). (22)

Although risk for cervical cancer is significantly higher with the presence of HPV infection, HPV infection alone may be insufficient to cause cervical cancer. Approximately 28 percent of women with HPV go on to develop CIN. (23) Current studies indicate HPV exposure is the initiating event. However, for the lesion to be persistent or progress to cervical cancer, other risk factors must be present. Over the past two decades, numerous epidemiological and laboratory studies have suggested nutritional factors may play an important role in the development and progression of CIN and cervical cancer.

Primary Prevention

Because a number of important epidemiological risk factors have been identified as contributing to the development of CIN and cervical cancer, primary prevention should be geared toward risk reduction. Of utmost importance with regard to risk reduction is the elimination of risky sexual behavior that increases exposure to HPV. Such behaviors include early sexual experiences, number of sex partners, and male partner factors such as history of venereal disease and number of sex partners. (24-26) The target population is primarily adolescents and young adults. (27) Women are most susceptible to potential carcinogens such as HPV during this period. (28)

It has been proposed that adolescents are at a greater risk for cervical dysplasia than adult females because of biological changes occurring in the cervix during puberty. (29) A study conducted by Massad and Anoina reported that cervical dysplasia is prevalent in as many as 21 percent of adolescent females. (30) In this population, sexual behaviors are initiated and lifelong patterns are established. Among sexually active adolescents, interventions should include increased condom use, improved communication with partners and peers, and addressing risk behaviors. It is also important for women to understand they can be infected with different strains of HPV with a new partner. Existing infection often lowers host immunity and makes women more susceptible to additional strains of HPV as well as other sexually transmitted diseases. Additionally, risk factors such as smoking need to be addressed at this time. There appears to be a significant correlation between risk of dysplasia and cigarette consumption. One study demonstrates the risk for cervical dysplasia rises with increased number of sex partners, dependent on the number of cigarettes smoked. (31)