. Sunday, December 7, 2008
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The last word any woman wants to hear following a Pap smear is “abnormal.” It is not, however, a reason for panic. “Abnormal” findings are extremely common and are usually due to easy-to-treat conditions such as inflammation, an infection or cervical erosion. It’s also possible to learn that you have what doctors call cervical dysplasia.

This condition often causes no symptoms––it’s simply the growth of abnormal cells on the cervix. (The cervix, located deep within the vagina, is the opening to the uterus.) But because some kinds of cervical cancer, doctors often treat cervical dysplasia aggressively, removing the cells in moderate or severe cases and, in mild cases, either removing cells or monitoring them closely with frequent Pap smears. (The cells may revert to normal or become increasingly abnormal.)

Protecting Yourself

Unlike heart disease or lung cancer, cervical cancer––and its precursor, cervical dysplasia––isn’t generally though of as a “lifestyle” disease. But population studies do link an increased risk for cervical cancer with some factors that are within your control. Following these tips will help you reduce your risk.

Get regular Pap smears. “The biggest risk factor for invasive cervical cancer is infrequent Pap smears,” says Ruth Peters, Sc.D., a professor of preventive medicine at the University of Southern California School Medicine in Los Angeles.

Most experts recommend that you begin getting Pap smears as soon as you become sexually active. After you’ve had three consecutive annual Pap smears that show all is normal, you shouldn’t need another for three more years. If the test shows that something cancerous may be brewing, more frequent testing is highly advisable, says Dr. Peters.

One study by researchers at the University of Washington found that women who hadn’t had a Pap test in ten years or more had 12 times the cancer risk of women who got checked more regularly.

Make it monogamous. The more sexual partners you’ve had, the higher your risk for cervical cancer. And if you’re faithful but he’s been sleeping around, your risks also shoot up. Why? Chances are you, through your mate, have been exposed to a virus associated with cervical cancer. “Strains of human papillomavirus (HPV) have been found in more than 90 percent of cervical cancer tissue samples.” Says Ralph Richart, M.D., director of the Division of Gynecological Pathology and Cytology at Columbia Presbyterian Medical Center in New York City.

Wait till you’re twentysomething. Because it may expose cervical cells to the sexually transmitted factor (perhaps HPV) at a time when they are particularly vulnerable, sex at an early age ups your risk for developing cervical cancer later, Dr. Peters says. “In one recent study, one partner before age 20 tripled a woman’s risk, and three or more sexual partners before age 20 increased the risk tenfold,” she says.

Use barrier methods of birth control. Condoms and diaphragms protect the cervix from contact with lots of potential irritants, including the HPV virus. In her study, Dr. Peters also found contraceptive creams, jellies and foams reduced cancer risks. Why? “They kill sperm, and they probably also kill whatever else might be transmitted,” she says.

Douche with discretion. Don’t douche your doctor tells you to. There is a misperception among many women that regular douching keeps you fresh and clean. Instead, it seems to reduce the body’s natural ability to fight off disease. “In one recent study, douching five or more times a month tripled the risk of cervical cancer,” says Dr. Peters.

Ditch your butts, and hi, too. Studies show that smoking triples your risk for cervical cancer, Dr. Peters says. “Nicotine and other chemical from cigarette smoke are concentrated in the cervical fluids,” she says. Those same toxins also end up in a man’s semen.

One study showed that women exposed to passive cigarette smoke for 3 or more hours a day had a threefold increase in cervical cancer.

Eat better. Numerous population studies have linked the development of cervical cancer with poor nutrition. Adequate intake of vitamins E and C, beta-carotene and folate seems protective.

Get Proper Treatment

What do you need to know if you are told you have cervical dysplasia? In a sense, you should be delighted that your doctor has found these abnormal cells. Early treatment can prevent them from turning into cancer.

Next you should be aware that your diagnosis should not be based on a Pap smear alone. “A Pap smear is a screening test, not a method of diagnosis,” says Robert Kurman, M.D., a professor and director of gynecologic pathology at John Hopkins Hospital in Baltimore.

An abnormal Pap smear indicating dysplasia should be followed by a biopsy of the cervix done with a colposcope, a viewing instrument that provides a magnified view of the cervix and allows the doctor to see any actual lesions, Dr. Kurman says. The biopsy removes small bits of tissue that are examined under a microscope. At the same time, the doctor may also scrape cells from the opening to the uterus, a procedure called endocervical curettage. Based on the examination of these two tissue samples, the doctor will decide how much cervical tissue needs to be removed and how it should be removed.

The tissue is most often removed by freezing (cryosurgery) or carbon dioxide laser surgery, both simple outpatient procedures. If the abnormal cells have invaded underlying tissue, a more radical surgical procedure, or radiation therapy, may be required.

A newer technique that uses a thin, electrically charged wire loop to scoop out areas of abnormal cells may be better than either cryosurgery or laser surgery, though, Dr. Richart says. “The procedure is easy to teach and learn,” he says. “It requires less expensive equipment than other methods of removal, allows biopsy and treatment to occur at the same time, which saves patients an additional office visit, and gives a complete tissue sample for examination, which will do away with missed diagnosis of invasive cancer.”


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