Cancer.
A word that often elicits an emotional, and physiological feeling in your body. Everyone knows someone who has had cancer, and as a result many of our lives have been impacted by it. A group of cancers which are commonly less spoken about are gynaecological cancers. This includes ovarian, uterine, vaginal, cervical, vulvar, and fallopian cancer. Of these cancers, cervical cancer is the only one of these which has a screening process.
What are the statistics?
Since 1991 the Australian incidence and mortality rate for cervical cancer has decreased by 50% (1). In 2022 it was estimated that 942 new cases of cervical cancer would be diagnosed in Australia (2).
Long standing infection of types of HPV (human papillomavirus) are the main cause of cervical cancer, as well as smoking, and having a weakened immune system (being chronically immunocompromised). The use of the oral contraceptive pill and giving birth to multiple children has also shown an association with increased cervical cancer risk, however this link is not well understood.
Around 9 in 10 people with a cervix will become infected with genital HPV during their lives (3). Luckily, most people who have the HPV infection never develop cervical cancer, and only a few types of HPV will result in cervical cancer.
Cervical intraepithelial neoplasia (CIN) is the development of abnormal cells in the cervix. This is most often caused by the human papillomavirus (HPV), which can lead to cervical cancer, or increase cervical cancer risk. These cells can change and resolve on their own without treatment, or sometimes treatments may be required. This is labelled on a rating of 1 to 3. The rating is based on how abnormal the cells are after being closely observed microscopically, and how much cervical tissue is involved.
The four things that can assist in preventing cervical cancer (or a HPV infection) is (4):
- Abstaining from smoking
- Having the HPV vaccine during adolescence
- Using barrier methods during sexual contact (use of dental dams, and condoms during oral, anal, and vaginal sex) – regardless of sexual partners (number of partners or gender of partners)
- To have your regular cervical screening tests every 5 years for those over the age of 25 with a cervix, so pre-cancers can be found in time to prevent progression.
When we speak about cancer, or any chronic illness, there are so many factors that feel outside our control. It can be helpful to focus on what we can control in these cases. Lifestyle factors are a common point of change for both individuals without cancer, and those who have gone through cancer treatments.
But is there a role of diet in cervical cancer prevention?
The answer is a little more complex than a simple ‘yes’ or ‘no’. Although nutrition may not be a direct cause of cervical cancer, it can influence risk factors and contribute to overall health. As with any cancer, it does not discriminate. The link between cervical cancer, nutrition and dietary intake has been studied in various research papers and observational studies.
In terms of cervical cancer and nutrition, the most significant role nutrition can play is in prevention, particularly around immune protection. Antioxidant intake is paramount when aiming to protect against any infection or illness. Antioxidants are substances that inhibit oxidation or remove damaging substances in a living thing. In simple terms, antioxidants protect our body cells. Antioxidants have varying abilities in intervening with disease progression, including the HPV infection. Specific vitamins (antioxidant vitamins) that have been shown to slow the growth and development of cancer cells, and improve immune function include vitamin E, vitamin C and vitamin A (retinoic acid).
Research has shown that those who consumed a “western diet” (defined by high intake of red and processed meats, dipping sauces, chips, and a low intake of olive oil) were at an increased risk of HPV infection (5) . This is due to increased inflammation in the body, which increases oxidative stress and damage to body cells. People who had a higher intake of a Mediterranean type of diet (rich in vegetables legumes, fruits and nuts, wholegrains, fish, and unsaturated fats) had a lower risk of HPV infection. Studies have also shown that consumption of brightly coloured vegetables and intake of fruit (lots of colour equals high antioxidant power) contributed to a 54% reduction in the risk of HPV persistence (6).
Key connections between cervical cancer and nutrition also include:
Folate
Studies have shown that women with higher blood folate levels have a reduced risk of developing cervical cancer. This could in part be due to increased overall vegetable intake, and intake of wholegrain carbohydrates. Folate is a B vitamin (B9) found in dark green leafy vegetables, legumes, and fortified grains. It plays a crucial role in DNA synthesis and repair, which can help in preventing cancer development. Folic acid (the supplemental form) might be useful in increasing intake. Studies have shown that a low folate intake is involved in development of cervical cancer, however this relationship in development of CIN is unclear (7).
Weight management
Excess weight has been linked to an increased risk of various cancers, including cervical cancer. Maintaining a healthy weight through a balanced diet and regular physical activity can help in reducing the risk of cancers, separate of weight. This interconnects with the theme of focusing on a diet high in fruits and vegetables (and foods rich in antioxidants), rather than focusing on a specific weight.
Immunocompromised individuals
Poor nutrition can weaken the immune system, making it less effective at fighting infections like human papillomavirus (HPV), which is the primary cause of cervical cancer. Adequate nutritional status is a strong predictor of shortened illness (in general) and lower susceptibility to infection. A strong immune system is essential in combating HPV and preventing it from progressing to cancer. The immune system is protected by nutrition factors such as appropriate intake of vitamin C, zinc, protein, and overall energy intake. The role of diet cannot be underestimated in protecting against infection.
Alcohol consumption
Excessive alcohol consumption can lead to nutritional deficiencies and weaken the immune system, both of which may contribute to an increased risk of cervical cancer. Alcohol intake can displace multiple nutrients, some of which are key in immune function, and cervical cancer prevention. These include vitamin A, C, D, E, K and B vitamins.
The Verdict:
While nutrition can play a role in the risk and prevention of cervical cancer, it’s essential to remember that other factors, such as HPV infection, smoking, and a weak immune system, also contribute to its development. Some of these things we unfortunately cannot control, and it is absolutely no person’s fault if they are diagnosed with cancer.
What we can control though, is maintaining an overall healthy diet high in vegetables, fruit, wholegrains, and lean protein, which can reduce risk of illness and improve immune function. It is also important to look at other lifestyle factors such as exercising regularly, avoiding smoking, and getting vaccinated against HPV, as all can help reduce the risk of cervical cancer.
