Why Do We Need a PAP Test? What is Cervical Dysplasia? And What Can We Do About It!?
WHY DO WE NEED A PAP?
As most women know, PAP tests are not the most exciting part about being a woman. However, PAP tests are very important for cervical cancer screening. Cervical cancer is preventable, but screening is the only way to detect early changes that might lead to cervical cancer. Since the cervical cancer screening program was initiated in the 80’s, 70% of cervical cancer diagnosed in Canada is diagnosed at stage I and 5 year survival rates have improved dramatically.
Cervical cancer screening should start by age 21 for women who are sexually active (this includes any activity involving the genital area, not just sexual intercourse). If a woman is not sexually active she should start having PAP tests by age 30. All women should continue screening every 1-3 years (depending on results) until the age 69. At 69, if a woman has had normal test results in her 3 previous PAPS then she can stop. This is because research has shown that cervical cancer is VERY rare in low risk populations under the age of 21 and over the age of 69. One exception to this screening schedule is pregnancy, a PAP test should NOT be performed during pregnancy but, screening should resume on schedule once the baby is born.
A woman should continue with regular screening, even if they have received the HPV vaccine since HPV is only responsible for 70% of cervical cancer. Other risk factors for cervical cancer include early age of onset of sexual activity, oral contraceptives (the pill), cigarette smoking, immunocompromised individuals (ie. Immune suppressing drugs, or immune altering infections like HIV), obesity and douching.
WHAT IS CERVICAL DYSPLASIA?
Cervical dysplasia is a precancerous condition that almost always precedes cervical cancer and is 100% treatable. It is when abnormal cells are detected on the surface of the cervix or the opening between the uterus and the vagina.
Dysplasia can be mild, moderate or severe and is initially detected by a PAP test. Mild dysplasia is called low- grade intraepithelial lesion (LSIL). Moderate to severe dysplasia is called high-grade intraepithelial lesion (HSIL). LISL and HSIL may or may not become cancer which is why further investigation usually follows their identification.
Once abnormality is detected a colposcopy is performed where the cells are investigated under a microscope. Depending on what the cells look like under a microscope a course of action is determined which includes monitoring more regularly, (every 6 months to 1 year) or a biopsy for further investigation.
Naturopathic medicine has many options for prevention and treatment of non-invasive cervical dysplasia, which I will be discussing below, but first I want to talk about HPV.
HOW IS HPV INVOLVED?
HPV (Human Papillomavirus) can infect the genital areas of both women and men (this includes the cervix, vulva, vagina, anus and penis as well as the throat). Approximately 75% of sexually active men and women will have at least 1 HPV infection in their lifetime. There are several types of HPV, some increase risk of cancer, especially HPV 16 and 18 which are responsible for 70% of cervical cancer. The highest risk for cancer-causing HPV infections is in women age 20-24. Infection rates often decrease as women get older because many develop immunity to the infection. Other types are low risk, such as HPV 6 and 11, and often cause genital warts.
The only way to prevent HPV infection is to completely avoid any genital contact but if you are sexually active, you can reduce your risk by having fewer sexual partners, being in a relationship with someone who has had fewer sexual partners, using a condom, as well as the HPV vaccine (which has greatest efficacy if used before the individual is sexually active).
There is an HPV DNA test that checks for the presence of high-risk HPV types. Though it is not standard practice, this test can be used to help a woman with cervical dysplasia to identify if they are more likely to develop cervical cancer. This test is NOT appropriate for women younger than 30 since women in this age group can have temporary HPV infections that do not result in pre-cancerous changes. In addition, for those seeking this test, it is not recommended for women over the age of 30 who have not had an irregular PAP test, and it is NOT to be used as a replacement for the PAP test.
- WHAT CAN WE DO ABOUT IRREGULAR PAP TESTS?!
- There is evidence that naturopathic treatments combining oral supplementation, vaginal suppositories and, in some cases cervical eschariotic treatments, can be used to treat LSIL and HSIL cervical changes successfully. In some cases, a woman may still need to undergo surgical intervention such as a LEEP procedure or cone biopsy, however, research shows that even in these instances, the women undergoing naturopathic treatment respond more successfully to these procedures. Here are some treatment options:
- 1) Vitamin D may decrease risk of cervical cancer and is a potential treatment for women with LSIL and HSIL. Studies have shown that women with HSIL given therapeutic high doses of Vitamin D showed regression of their dysplasia compared to those who did not have the treatment. In addition, research shows that women with low vitamin D status are at an increased risk of HPV infection.
- 2) Green Tea. Studies have shown that in patients with cervical changes that had confirmed HPV infection, green tea taken either orally or topically (intravaginally) had improvement compared to those who did not have either treatment. In addition, those how received the treatment topically had the most significant improvement.
- 3) Indol-3-carbinol (I3C), a compound found in cruciferous vegetables, has been found to decrease the risk of many female cancers. Studies on women with LSIL and HSIL showed a greater regression in women who were given I3C compared to those who weren’t. In addition, women who had to have a LEEP procedure responded significantly better if they had been taking I3C compared to those who didn’t.
- 4) Folate (MTHF), is a very complicated topic since its metabolism is strongly dependent on genetics. Studies have shown that women with low folate status and those with the genetic mutation that does not allow them to absorb folate from folic acid have increased risk of cervical cancer. Supplementation with folate (in appropriate form) could be another potential treatment option and is used by many naturopthic doctors in the treatment of various degrees of cervical dysplasia.
PAP tests are extremely important and should never be skipped. If you are uncomfortable with your GP or your Gynecologist, then ask your naturopathic doctor to can perform your vaginal exam for you. At Health Over All, we are equipped to perform a PAP tests and if necessary vaginal swabs. With more time, we are able to make the test more comfortable for our most sensitive patients. In addition, we can perform PAP tests outside of the regular screening guidelines for those who want additional screening.
Lastly, if you have an irregular PAP test, whether it is LSIL or HSIL, you do not need to just watch and wait. As Naturopathic Doctors we have many effective tools to help improve your prognosis even if you do eventually need to have a surgical procedure such as a LEEP or biopsy.
Dr. Lisa Maddalena