(cervical cell changes on Pap)
color pencil illustration by Suzanne L. Adams, CT (ASCP)
*HPV infection is a sexually transmitted viral disease effecting primarily the cervix, but also the male genitalia, oral cavity, and esophagus D'Souza G, 2007). Viral changes in cervical cells can often be detected on routine Pap tests. The virus is more commonly seen in anemic younger women (>30 years old), contraceptive hormone users, smokers, alcohol users, the poor, during late pregnancy, and in periods of low immunity (Moreno V, 2002, Santos C, 2001, Broker TR, 2001, Thomson SW, 2000).
HPV has been found in association with low folic acid and antioxidant micronutrient status (Hernandez BY, 2003, Kwasniewska A, 2002 & 1997, Harper JM, 1994). Folic acid has been shown to have a protective effect against the development of HPV, and improving folate status in people at risk of getting infected or who are already infected may have a beneficial impact in the prevention of cervical cancer (Piyathilake CJ, 2004). Many cases of HPV resolve on their own but certain strains, such as HPV-16, 18, 30, 33, and 45, are considered more aggressive and may lead to cervical cancer. HPV-DNA testing has shown that virtually all cervical cancers test positive for HPV with over 90% of them testing positive for HPV-16, 18, and 45 (Munoz N, 2003, Ngelangel C, 1998).
Women who are HIV positive are particularly vulnerable to HPV and often have unrelenting reoccurrences that quickly progress to invasive cervical cancer (Lee YC, 2000). HPV is so common in HIV positive women, it is now listed as an AID's defining illness.
HPV is at epidemic proportions, although early detection through Pap tests is helping to reduce its occurrence and deaths from cervical cancer worldwide. Cervical cancer kills approximately 300,000 women worldwide. Recent studies have also strongly linked certain strains of HPV, especially HPV-16, with the pathogenesis of squamous cell carcinoma of the throat in both men and women (D'Souza G, 2007).
There are now two approved vaccines, Gardasil and Cervarix, that provide substantial protection against the most common high risk types of HPV (HPV16 and 18, which cause about 70% of cervical cancers, and HPV 6 and 11, which cause approximately 90% of genital warts) in girls and young women (9-26 years of age) who have not yet been exposed to the virus. While the vaccines provide almost 100% protection against the above four HPV strains, they may increase the risk of developing lesions that lead to cervical cancer in women already exposed to the virus. Rare but serious side-effects, including paralysis and seizures, have been reported. The vaccines do not protect against less common strains of HPV that may lead to cervical cancer, such as HPV-30 and HPV-33, so regular Pap tests are still required after vaccinations.
HPV is not the only way cervical cancer can occur. Cervical cancer (endocervical glandular type) is also associated with long-term contraceptive hormone use. If one studies the history of the Pill and the Pap smear, it will be found that in order for physicians to prescribe the Pill to any women, a yearly Pap smear and pelvic and breast exam had to be performed at the same time, including with each new yearly refill. That was the compromise for allowing the Pill on the market in the US in 1961 (see excerpt from The Art of Cytology) This was because studies showed conflicting benefits with some reporting showing an increased risk of cervical and breast cancer as well as blood clots and strokes. Long-term Pill use (>5 years) as well as Depo Provera injections (a progestin only contraceptive) were shown to cause endocervical hyperplasia (a possible precursor to endocervical cancer) (Velente PT, 1998). . The lesion was actually coined by pathologists as an" oral contraceptive lesion"
In the early days, many of the best gynecologists took not only cervical smears (ectocervical), but also endocervical and vaginal smears (three slides altogether) to check not just for cervical but also for endocervical, endometrial, and vaginal cell abnormalities. Vaginal adenosis and vaginal clear cell carcinoma were already known to be the result of exposure to the first synthetic estrogen, DES (diethylstilbestrol) in the 1950's. This drug was prescribed to pregnant women with the mistaken belief that it would help prevent miscarriages and even possibly produce more robust babies as one doctor noted. The vaginal smear was also used to detect occult endometrial cancer as the cells tend to hang out in the vaginal fornix. These smears were also used to monitor the effects of exogenous estrogen that many doctors were prescribing to menopausal women for vaginal atrophy and associated discomforts. The endocervical smear was taken to make sure the squamo-columnar junction was reached which is where cervical cancers most often arise.
Now the Pap Test has turned into mainly a test to detect HPV which is only part of the problem of cervical cancer. As studies point out, it takes more than just HPV to cause cancer. A poor immune system, tobacco use, malnutrition, and hormone use all contribute and should continue to be researched and addressed. The increase in endocervical glandular cancers in young women since the introduction of the Pill is significant and should not be ignored (see excerpt from The Art of Cytology).
Cytology Features of HPV
*Hallmark cellular changes in epithelial cells of the cervix are mild to moderate dysplasia with koilocytotic atypia (a peculiar wide clearing of the cytoplasm around the nucleus). Koilocytotic atypia is pathognomonic of HPV. Identification of HPV on Pap tests is always given an abnormal interpretation. Frequent repeat smears and other follow-up tests are often recommended for several years after an HPV lesion is initially diagnosed.
About the Booklet
A 72 page color spiral-bound booklet containing over 50 color drawings and photos along with current well-researched statistics and information that explain in a nutshell how life-style practices, including optimal micronutrient intake, can significantly reduce the risk of disease processes, particularly HPV, cervical cancer, and NTD-related birth defects (eg: Spina bifida). This booklet contain several new drawings by Suzanne such as folic acid/B12 deficiency changes in red blood cells, the interior of an artery showing atherosclerosis, stages of the neural tube during embryonic development showing NTD defects, and a child born with a cleft palate and lip. Color photographs include real cytology cases of cervical cancer, HPV, and folic acid deficiency, plus various others types of photos to enhance the presentation.
This booklet was created to assist the public as well as health and science educators in understanding the crucial role nutrition and optimal life-style practices play in protecting the human genome from cancer, genetic defects, and disease processes. It was also created to help support the diligent efforts of the CDC, the March of Dimes, the Spina Bifida Association of America, and the American Cancer Society in their mission to prevent cancer, birth defects, and diseases processes.