Cervical cancer: putting prevention into practice.

Worldwide, cervical cancer ranks fifth for cancer mortality in women. (1) In 2006, an estimated 10,000 women in the US will have been diagnosed with cervical cancer, and nearly 4,000 will die from it. (2) Estimated new cases of cervical cancer in 2008 are 11,070 and deaths 3,870. (3)

Cervical cancer is the second most common malignant cancer found in women between ages 15 and 34. It is one of the few cancers that have well-defined precancerous stages, which allows for successful treatment with early detection and diagnosis. (4), (5)

Since its introduction in 1941, the Papanicolaou (Pap) smear has made one of the greatest positive impacts as a preventive screening tool in the world of public health. It has reduced the incidence of cervical cancer in the US by 75%, and the death rate continues to decline by 4% a year. (6)

Although current treatments for cervical cancer and cervical dysplasia (a condition characterized by abnormal cells indicating precancerous or cancerous cells) include surgery, radiation, and chemotherapy, there is growing biologic and clinical evidence that a more powerful treatment is the combination of secondary prevention and cellular therapy through nutrition and lifestyle interventions.

Good science moves ahead by combining scientific methods, empirical data, clinical observations, evidence, and outcomes, not a show of hands. Scientific consensus is not how science works. Merriam-Webster Online dictionary defines "science" as a systematized knowledge derived from observation, study, and experimentation carried on in order to determine the nature of what is being studied. Essentially, this definition has been diluted and ignored by institutions. So much science is manipulated and driven by dollars, convenience, and special interests today.

Scientific advances historically come from a small group of scientists who challenge the conventional wisdom or majority view. Individuals such as Galileo or Einstein come to mind. Good scientists know that correlation is not causation. The approach to cervical cancer prevention is no exception.

Risk Factors

Human papillomavirus: It is widely known that the human papillomavirus (HPV) is the most prominent risk factor for cervical cancer. The DNA of HPV is detected in virtually all cervical cancers, with HPV subtypes 16, 18, and 31 identified most frequently; yet there are other significant factors that increase the risk of the development of this disease, such as the use of birth control pills, smoking, age, multiple sex partners, and nutritional deficiencies.

Because cervical cancer is nearly 100% preventable through lifestyle behaviors, avoidance of known risk factors is the best way to avert cervical cancer and dysplasia.

Age: Rates of cervical carcinoma in situ (cervical cancer that has not spread to other parts of the body) reach a peak in both black and white women between ages 20 and 30. The number of cases of invasive cervical cancer increases after age 25 in white women and black women, but more rapidly in black women. The chance of dying of cervical cancer increases as a woman gets older. (7)

Pap test (smear) history: The Pap test has been used since the 1940s to screen for endocervical cancer and other potential cellular changes on the cervix. It has become the most widely used cancer screening technology in the world. (8) Women who have never had a Pap test or who have not had one for several years have a higher-than-average risk of developing cervical cancer. In most cases, the disease is slow to progress, so early detection and treatment provide a positive outcome.

HPV infection: There are more than 100 types of human papillomavirus (HPV). At least two dozen are transmitted sexually and can infect the cervix. About half of these have been linked to cervical cancer. Cervical infection with HPV is the primary risk factor for cervical cancer. However, although HPV infection is very common, only a very small percentage of women infected with untreated HPV develop cervical cancer. Not every woman who comes in contact with the HPV virus gets infected, and not every infected cervix develops cancer. Some women have stronger immune systems that prevent the initial infection by the virus. Other women who get infected may fight off the HPV and prevent it from developing into cervical cancer. Generally, the immune system can handle HPV, which is often without symptoms; and outbreaks of the virus come and go. But when the virus persists or comes from a high-risk strain, it can cause cervical dysplasia.

HIV infection: Women who have been infected with HIV have a higher-than-average risk of developing cervical cancer. They are more likely to have abnormal vaginal discharge on physical examination, infection with a high-risk type, and cervical dysplasia The prevalence of abnormal vaginal discharge and bacterial vaginosis increases significantly with decreasing CD4 (T-cell) count. (9)

Sexual history: Women who first had sexual intercourse before age 18, have had many sexual partners, or have borne a child before age 16 have a higher-than-average risk of developing cervical cancer. As discussed above, some sexually transmitted diseases (STDs) such as HPV and HIV infection, as well as genital herpes, may also increase risk. Abstinence or establishing a monogamous relationship will reduce the risk of cervical cancer significantly. (10) It is an additional challenge that, biologically, womanhood is ignored and replaced with social trends, medical technology, and the dominion of medical experts, thus separating woman's sexuality from her natural core.

Smoking: The association between smoking and cancer of the cervix has been established. (11) Women who smoke are about twice as likely as nonsmokers to get cervical cancer. (12) Among HPV-exposed women, an increased risk of cervical cancer was observed in those who smoked, with a greater risk for current than for former smokers. Overall, the etiologic role of smoking as a HPV cofactor is prominent regardless of study design and control selection. It is unclear whether the risk of cervical cancer posed by smoking is immunologic (reducing HPV clearance) or genotoxic (more directly promoting neoplastic progression). (13), (14)

Immunosuppression: Increased risk for developing cervical cancer is related to the immune response. Scientists believe that the immune system plays a vital role in destroying cancer cells and slowing their spread to other organs. (15) A robust immune system is a critical determinant in how oncogenic HPV infection will affect a woman. A healthy immune system is necessary to avoid infection that may lead to the development of cancerous cells. Strengthening the immune system can prevent viral infection in the first place.

Low folate levels: Low folate levels are heavily implicated in the development of cervical cancer. Cervical dysplasia is the precursor of cervical cancer and is usually first detected through a routine Pap smear. Fortunately, folate supplementation (0.8-3.0 mg/day) is very effective in reversing cervical dysplasia and preventing the cancer. (16-18)

Researchers at the Harvard Medical School report that women who supplemented with folic acid (0.4 mg/day or more for at least 15 years) had a four times lower risk of developing colon cancer than did women with a daily intake of 0.2 mg/day or less (the daily contribution of a typical North American diet). (19-21)

Oral contraceptives (OCs): With the introduction of OCs and resulting trend toward sexual freedom (multiple partners), not only has the rate of STDs increased, but so has cervical cancer. Oral contraceptives also affect nutrient levels. Women who use synthetic contraceptives tend to be deficient in vitamin B6 and the antioxidant beta-carotene. Studies have shown that oral contraceptive pills deplete the body of B vitamins, and their use is known to increase the risk of cervical dysplasia. (22)

The relationship between the use of OCs and cervical cancer is controversial. Evidence shows that long-term use of OCs (5 or more years) may be associated with an increased risk of cancer of the cervix. (23) Women who used OCs for less than five years had no increase in risk of squamous-cell cervical cancer, compared to women with HPV who had never used OCs. In contrast, the use of OCs over 5 to 9 years was associated with an almost threefold increase in risk, compared with nonusers, and a fourfold increase for usage of 10 years or longer. These estimates of risk were higher than those reported in most other studies. (24)

Diethylstilbestrol (DES): In 1984, The New England journal of Medicine published the first major study of breast-cancer risks for DES mothers. They had a 40% to 50% greater risk than non-DES users. Many DES daughters have benign tissue and structural damage to the vagina and cervix relating to their DES exposure. Dr. Ellen Grant, in her book The Bitter Pill: How Safe Is the "Perfect Contraceptive"? reports that daughters of women who used the synthetic estrogen DES during pregnancy also have an increased risk of vaginal and cervical cancer, miscarriage, ectopic pregnancy, stillbirth, premature labor, and sterility. This is something to consider when reviewing a patient's health profile.

Vaccination/Gardasil: In June 2006, the US Food and Drug Administration (FDA) announced that it had approved a new vaccine called Gardasil, which protects against four specific strains of HPV, two of which are associated with genital warts and the other two with cervical cancer. A public awareness campaign ensued emitting fear about cervical cancer, instead of reporting good science and promoting prevention.

Gardasil has only four years of clinical history. We have no idea what the safety profile and adverse reaction rate will be when the vaccine is given to large numbers of young people over a longer period of time. The FDA has expressed concern that this vaccine has not been tested to determine if it might cause cancer, impair future fertility or reproduction, or harm fetuses developing at the time of the mother's vaccination. Haste to promote the use of this vaccine without more thorough scientific understanding is not in the best public interest and should be restrained. (25) There are safer options to explore for prevention.

Except in emergency situations, practitioners should make a preferential use of nontoxic and low-technology therapies that have been shown to be effective. Currently, there is a lack of safety outcomes and controversy around this vaccine, particularly since it is prescribed for a condition that is 100% preventable.

Why Food and Nutrients for Cancer Prevention?

No matter the extensive research and attempt to place safety first in conducting clinical trials, there is no such thing as a harmless drug. American Heritage Dictionary defines "pharmacology," derived from the Greek pharmakeia, to mean "magic charm or poison." In contrast, the word "vitamin" combines vita, which stands for "life," and amine, meaning "characteristics of a substance." Together this defines vitamins as essential or vital for life forces.

Foods that contain micronutrients work synergistically, rather than like a drug as an individual substance. A minimal daily intake of nutrients is necessary as a basic preventive measure for the optimal function of the human body. Health and disease-prevention are determined by the function of millions of cells that fulfill multiple functions. (26) Gland cells produce hormones, white blood cells produce antibodies, and heart muscle cells generate and conduct biological electricity for the heartbeat, all of which is determined by the genetic programming within each cell core. (27) Vitamins and essential nutrients are needed for the thousands of biochemical reactions taking place in each cell. (28) Optimum dietary supplementation of vitamins and other essential nutrients is the key to health and effective treatment for chronic health conditions. (29)

A healthful diet, which includes fish, organic whole foods with complex, low-glycemic index carbonhydrates, and raw dairy products complements the use of supplements. (30) An orthomolecular approach that includes eliminating junk foods such as refined sugars, food additives, and chemicals is considered therapeutic as well.

The Evidence

In 2002, The Journal of the American Medical Association (JAMA) reversed its policy of 20 years and encouraged all adults to take a multivitamin every day. Robert H. Flectcher, MD, MSc, and Kathleen M. Fairfield, MD, DrPH, of Harvard Medical School and the Harvand Medical School and the Harvard Medical School and the Harvard School of Public Health reviewed more than 30 years of articles about vitamins in relation to chronic diseases and published their findngs in June 2002 in two companion articles.

In the scientific review article, the two physicians consider the evidence that suboptimal intakes of a number of vitamins are associated with increased risk of chronic diseases, includng cardiovascular disease, cancer, and osteoporosis. In a clinical commentary, they note that "a large proportion of the general population" has less-than-optimal intakes of a number of vitamins, making them more vulnerable to disease.

Studies find that people who use more supplements are healthier than those who do not take supplements. Researchers divided patients into non-supplement users, single-supplement users, and multiple-supplement users, and looked at their risks of a wide array of diseases as well as any associations between supplement use and income.

After accounting for age, education, income, and body mass index, the researchers found that compared to non-upplement users, multiple-supplement users had 22% to 73% less risk of several chronic conditions and diseases such as high blood pressure, diabetes, heart attack, coronary heart disease, and emphysema.

The researchers concluded that "multiple supplement users were more likely to be long-term supplement users" and that this long-term supplement use led to "optimal concentrations ... associated with [improved health status]." (31)

For skeptics who complain about the lack of scientific evidence, they need to look no further than within the current scientific community. In the allopathic world of practicing medicine, many popularized procedures cannot stand scientific scrutiny. Approximately 85% of all therapies and procedures that are commonly used by physicians and in hospitals had never received any kind of rigorous evaluation. (32) Furthermore, a scant 17% to 20% of conventional medical practices are based on scientifically validated evidence and 80% to 83% are based solely on anecdotal data. (33)

David A. Grimes of the University of California, San Francisco School of Medicine states: "[M]uch, if not most, of contemporary medical practice still lacks a scientific foundation." Grimes provides examples of unproved but widely practiced orthodox therapies:

* radial keratotomy

* laparoscopic vaginal hysterectomy

* episiotomy 

* chemotherapeutic, immunologic, or physical methods of "purging" prior to autologous bone marrow transplantation 

* noninvasive electrical stimulation for ununited bone fractures. (34) Richard Smith of the British Medical

Journal agrees. He states that "only about 15% of medical interventions are supported by solid scientific evidence. This is partly because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all." (35)

Dietary Recommendations

Over the past several years, research has disclosed that foods contain thousands of potentially bioactive substances that influence receptor sites on every cell in the body. (36)

* Eat whole, natural foods, preferably raw. Uncooked fruits, vegetables, seeds, and so on, are superior to cooked foods in nutritional value. All forms of cooking reduce and destroy the nutritional qualities of any food. Do not use a microwave oven. Vital enzymes are destroyed, and essential fatty acids become unstable in high temperatures.

* Eat fresh fruits and vegetables, preferably organic, in salads and soups or lightly steamed. A report by the National Academy of Sciences on the relationship between diet and cancer, based upon the survey of over 10,000 research papers, recommended greater emphasis on fresh fruit and vegetables in the diet. Research shows that they protect against a variety of cancers and contain vitamins and minerals which strengthen immunity. They also contain phytochemicals that are biologically active compounds which protect the body at the cellular level that can lead to cancer.

* Eat organic grass-fed meats and poultry, wild (not farmed) seafood, game, organ meats, and eggs. Avoid cured meats with nitrate additives. (37)

* Eat whole, naturally produced milk products from pasture-fed cows, preferably raw and/or fermented, such as whole yogurt, cultured butter, whole raw cheeses, and fresh sour cream. Avoid low-fat or nonfat products, which are often laced with additional chemicals. (38)

* Use only traditional fats and oils, including butter and other animal fats in moderation, extra-virgin olive oil, coconut oil, and nut oils. Avoid trans fats and hydrogenated oils.

* Consume whole grains and nuts daily.

* Include enzyme-enhanced lactofermented vegetables such as sauerkraut, fruits, beverages, and condiments in your diet on a regular basis.

* Prepare homemade meat stocks from the bones of chicken, beef, lamb, or fish; and use liberally in soups and sauces. Cook these stocks for at least four hours.

* Use only organic teas and coffee.

* Use filtered water (preferably from a reverse-osmosis system or distilled water) for cooking and drinking.

* Use unrefined Celtic sea salt and a variety of (non-GMO) herbs and spices for food interest and appetite stimulation. Although some studies have suggested sodium restriction, a therapeutic approach suggests that the balanced intake of potassium, calcium, and magnesium is better for overall health.

* For salad dressing, use vinegar and oil with salt and pepper. Avoid all bottled dressings.

* Use natural sweeteners in moderation, such as raw honey, maple syrup, dehydrated sugar cane juice, stevia powder, and xylitol.

* Drink unpasteurized wine or beer in strict moderation with meals.

* Use only stainless steel, glass, or cast iron for cooking.

* Use natural supplements, not synthetic. (39-47)

A whole-systems approach of lifestyle behaviors is the foundation for health promotion and disease prevention. Scientific evidence repeatedly shows this approach to exceed the power of a pharmacological intervention. (48)

Therapeutic Nutritional Supplements

The science of nutrition can be traced back to 400 BC, when Hippocrates stated, "Let food be thy medicine and medicine be thy food." Vitamins and minerals help regulate the conversion of food to energy and defend against damaging toxins from environmental pollutants, drugs, alcohol, radiation, and chemicals. Historically, clinicians have only recognized nutritional deficiencies if they manifested as disease such as rickets, pellagra, or beriberi.

Nutritional scientists have known for some time the value of individual biochemistry and nutritional status. Prevention of nutritional deficiencies is the first line of defense to decrease the incidence of illness and disease.

Vitamin D: Ultraviolet B radiation from the sun converts cholesterol to vitamin D, one of the most potent anticancer vitamins. A summary paper on the NCI meeting to be published this fall in the Journal of Steroid Biochemistry and Molecular Biology reports that there was general agreement that vitamin D deficiency is associated with a higher prevalence of cancer (and several other diseases), and that the vitamin D hormone can decrease the proliferation of cells and control malignant cell growth. "If you want to increase your vitamin D levels, the safest way is to take supplements," said Dr. Sue Ingles of the University of Southern California, and coauthor of a new study on sunlight and advanced prostate cancer among men in San Francisco. Cancers can be reduced by 77% when taking vitamin D3 (cholecalciferol). (49) The significance of this study urges all Americans to take at least 1,000 IU of vitamin D daily to avoid deficiency.

Indole-3-carbinol (13C) comes from Brassica vegetables (which include cabbage, broccoli, bok choy, brussels sprout, cauliflower, kale, kohlrabi, mustard, rutabaga, and turnip) and acts as a metabolic modifier that affects the "good/bad" estrogen ratio. These vegetables contain sulfur compounds that have been shown to convert to another indol, diindolylmethane (DIM) by stomach acid, that acts as an estrogen modulator and can prevent and/or treat estrogen-related cancers such as breast or cervical cancer. The British Journal of Cancer reported that genistein (a soy isoflavone) and 13C enhance DNA repair and partly account for the ability of increased vegetable intake to reduce the risk of cancer. The study is also among the first to discover a cellular explanation for the correlation between increased vegetable intake and reduced risk of cancer. (50)

In another study, associates treated a particular condition called cervical intraepithelial neoplasia (CIN; also known as cancer in the epithelium of the cervix in the intermediate stages of its development [stages 2 and 3]), with a substance extracted from the Brassica vegetables. When this substance, which occurs naturally in these cruciferous vegetables, was administered during the course of only 12 weeks, between 40% and 50% of these stage-2 and stage-3 CIN cancers literally disappeared. (51) This study has created quite a stir in the medical community, even though the use of 13C is implicated as a standard protocol for cancer prevention.

In a placebo-controlled human trial, 200 mg/day 13C resulted in complete regression of cervical precancerous growth in four of eight patients, and 400 mg/day resulted in complete regression in four of nine patients. In the placebo group, no patients had complete regression. (52)

Diindolylmethane (DIM) is another metabolic modifier that alters the 2/16-alpha-hydroxyestrone ratio. It naturally occurs in Brassica vegetables and has been observed as considerably more potent in changing the 2/16-alpha-hydroxyestrone ratio. Studies with 13C or DIM indicate a benefit for their use in the treatment of CIN and prevention of cervical cancer. (53)

Vitamin C is a powerful antioxidant that functions to form collagen, a primary protein used to make connective tissue and form scar tissue. It is necessary to form bone and cartilage. Therapeutic uses include treatment for cancer, cataract development, cardiovascular disease, and cervical dysplasia prevention. (54) As a water-soluble vitamin, it is very safe and can be used daily even in doses over 10g (10,000 mg) for extended periods of time. Although the minimum daily requirement is 60 mg/day, physical stresses, surgery, infection, exposure to toxic chemicals and foods, smoking, and chronic use of medications all increase the physiological need for vitamin C. (55)

Folic acid (B9): Historically known for the prevention of severe birth defects including spina bifida, it is vital to DNA and RNA synthesis, cell division, and maintenance of the genetic code. Folic acid deficiency has been shown to play a role in cancers of the cervix, lung, and colon, possibly through its action in DNA synthesis. (56) A lack of folic acid also is related to an increased risk of blood vessel disease, depression, and dementia. The good news is that folate deficiency is easy to diagnose and prevent. Foods containing good sources of folate include all greens (foliage), beans, nuts, and wheat germ. Liver (from organically raised animals) is one of the very best sources, along with other organ meats, oysters, salmon, and brewer's yeast. Therapeutic doses begin at 400 mcg to 1,000 mcg/day.

Other B vitamins: Women with low dietary intakes of vitamins B1 (thiamine), B2 (riboflavin), B12 (cobalamin), and folic acid may be more at risk of developing cervical dysplasia, according to a study done among multiethnic women in Hawaii. The findings suggest that increasing the intake of these vitamins may help prevent the development of cervical cancer. (57)

Multivitamins: Mounting scientific evidence continues to support the use of a multivitamin as foundational for optimal health. A good foundation is essential to compensate for dietary inadequacies. Additional supplementation can be tailored for more specific nutritional needs.

Antioxidants can be vitamins, minerals, or enzymes; and they exist in foods such as fruits, vegetables, and whole foods. Research indicates they help to protect genes against mutation. This is one reason that humans who consume higher levels of antioxidants and other plant extracts often have lower incidences of cancer.

Women at high risk for developing cervical cancer had "significantly decreased levels of beta-carotene, lycopene, canthaxanthin, and alpha-tocopherol compared to the controls," according to one study. (57) Findings supports an association between decreased antioxidant nutrient levels and cervical cancer. Scientists hypothesized that the free-radical fighting ability of these nutrients is responsible for their role in cervical cancer. These antioxidants prevent mutational changes to DNA, the basic building blocks of life, that would predispose the body to cancer.

One may conclude that a body hungry for antioxidants is vulnerable to cervical (and other forms of) cancer. Conversely, a high intake of antioxidant nutrients appears to be powerfully protective against cancer. (58)

Therapeutic Lifestyle Approach

Pathology continues to drive our 21st-century medical model, which paves the way for the creation of new conditions and diseases. This is all well and good, but without an understanding of the origin of a condition, preventive lifestyle behaviors and their relationship to illness get lost.

Nutritional science, biology/ cellular health, human physiology, and causation of disease are the new approach to determining health and healing protocols for not only cancer but all diseases. The human is a matrix of connections that respond to the laws of nature versus laboratory synthetics. Dis-ease does not just appear, but evolves over time relative to our toxic environment, genetic predisposition, adulterated and denatured foods, tainted water supplies, polluted air, synthetic drugs, emotional stresses, and overstimulating activities.

Cervical Cancer Prevention Protocol

Encouraging patients to take personal responsibility and learn about their bodies is key. Patients who educate themselves, listen to their bodies, avoid prescription drugs, and eat a wholesome diet (not low-fat, no-fat, low-protein, low-calorie, low-salt diets) are healthier. Protein, good green foods, sea salt, and water have protective factors, whereas prescription drugs have too many adverse effects. Our bodies are not drug deficient. With confounding factors and differences that exists amongst all people, this foundational approach creates healthier outcomes for patients.

* Do not smoke.

* Choose organic foods: Pesticides used In agricultural production have been shown to cause leukemia-associated (cancer type) changes, lower the antioxidant-fighting ability of the body's enzymes, while genetically engineered foods raise other health concerns. (59)

* Eat a high proportion of raw foods: see the dietary recommendations above.

* Exercise: Activity decreases risk of all cancers and other chronic diseases. Researchers have found that about 30 minutes of exercise three to four times per week may help decrease risks of several types of cancer, including breast, endometrial, prostate, colorectal, and lung cancers. According to the National Cancer Institute, physically active women have a 40% reduced risk of developing breast cancer, and physically active men have a 10% to 30% reduced risk of developing prostate cancer.

* Limit sexual partners: a science-based culture often ignores health and safety outcomes. In fact, in a relationship in which one or both partners are infected with HPV, by remaining monogamous the couple helps lower the risk of infection from another strain of the virus.

* Get screenings: The Pap smear is still a very powerful means of cervical cancer prevention.

* Use supplements: Nutrient deficiency is epidemic. Research highlights the potential of individualized nutrient therapy to not only prevent and eradicate disease, but to also create "metabolic harmony." Optimum intakes of micronutrients can provide a significant increase in health. (60)

* Avoid oral contraceptives/ synthetic hormones. The use of synthetic estrogens, in the form of birth control pills, hormone replacement therapy (HRT), environmental estrogens from feed lot animals, insecticides, and pesticides, is creating unprecedented growth of this condition.

Healthful behaviors and nontoxic interventions have made cervical cancer almost 100% preventable for women. There is a great deal of hope that clinical training in nutritional science, education, personal responsibility, and lifestyle therapies will eradicate this condition completely. If we are up to the challenge of new and improved thinking, the old school of medical science will take us back to a health model that will focus on just that ... health and prevention.

Notes

(1.) American Cancer Society Statustucs 2006.

(2.) World Health Organization. Fact Sheet No. 297 [Web page]. February 2006. http://www.who.int/mediacentre/factsheets/fs297/en.

(3.) National Cancer Institute. Cervical cancer [Web page]. Natioal Institutess of Health website. http://www.cancer.gov/cancertopics/types/cervical.

(4.) Cotran RS, Robbins SL, Kumar V. Robbins Pathologic Basis of Disease. 3rd ed. philadelphia: W.B.Saunders; 1984.

(5.) Rubin P. Clinical Oncology, 6th ed. New York: American Cancer Society; 1983.

(6.) Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics. CA Cancer J Clin. 2001; 50: 7-33.

(7.) National Cancer Institute. Cervical cancer: screening-health professional information 2002. Available at: http://health.yahoo.com/cervical cancer-diagnosis/cervical-cancer-screnning-healthprofessional-information-nci-pdq/healthwise--ncicer0000062756.html.

(8.) Casper MJ,Clarke AE. Making the Pap smear into the "right tool" for the job: cervical cancer screening in the USA, circa 1940-95. Soc Stud Sci. April 1998;28(2):255-290.

(9.) Rugpao S,Nagachinta T, Wanapirak C, et al Increased risk for cervical dysplasia in HIV-infected Thai women. Cancer Detect Prev Suppl. 2000(24 supplement 1).

(10.) Women's Cancer Network. http://www.wen.org.

(11.) National Cancer Institute. What you need to know about cancer of the cervix [Web page]. February 2002. National Institutes of Health Publication No. 08-2407. http://www.cancer.gov/cancertopics/wyutk/cervix.

(12.) American Cancer Society. What are the risk factors for cervical cancer? [Web page] August 4, 2006. http://www.cance.org.

(13.) Castle PE, Wacholder S,Lorincz AT, et al. A prospective study of high-grade cervical neoplasia risk among human paillomavirus-infected women. J Natl Cancer Inst 2002;94(18): 1406-1414.

(14.) Deacon JM, Evans CD, Yule R, et al. Sexual behavior and smoking as determinants of cervical HPV infection and of CIN3 among those infected: a case-control study nested within the Manchester cohort. Br J Cancer. 2000;83:1565-1572.

(15.) Shiffman M,Herrero R, Hildesheim A, et al. HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica. JAMA. 2000;283:87-93.

(16.) Murray MT. Encyclopedia of Nutritional supplements. Rocklin, CA: Prima Publishing; 1996.

(17.) Passwater RA. Cancer Prevention and Nutritional Therapies. New Canaan, CT: Keats Publishing Inc.,1993.

(18.) Butterworth CE Jr, Hatch KD, Mueller H, Gore H. Folate-induced regression of cervical intraepithelial neoplasia in users of oral contraceptive agents. Am J clin Nutr. 1980;33:926.

(19.) Giovannucci E, Stampfer MJ, Colditz GA, et al. Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study. Ann Intern Med. October 1, 1998;129(7):517-524.

(20.) Kim YI, Fawaz K, Knox T, Knox T, et al. Colonic mucosal concentrations of folate correlate well with blood measurements of folate status in persons with colorectal polyps. Am J Clin Nutr. October 1998;68:763-764,866-872.

(21.) Kato I, Dnistrian AM, Schwartz M, et al. Serum folate, homocysteine and colorectal cancer risk in women: a nested case-control study. Br I Cancer. April 1999;79(11/12):1917-1921.

(22.) Hemandez, By, McDuffie K, Kamemoto L, Goodman MT. Diet and high grade premalignant lesions of the cervix evidence of a protective role for folate, riboflavin, thiamin and vitamin B12. Cancer Causes Control. 2003;14(9):859-870.

(23.) Franceschi S. The IARC commitment to cancer prevention: the example papillomavirus and cervical cancer. Recent Recent Results Cancer Res. 2005;166:277-297.

(24.) Skegg DCG. Oral contraceptives, parity, and cervical cancer [Commentary]. Lancet. 2002;359:1080-1081.

(25.) Moss R. New report on Gardasil vaccine. The Moss Resports Web site. March 4, 2007. http://cancerdecisions.com/030407.html.

(26.) Salonen JT, Salonen R, Seppanen K, et al. Effects of antioxidant supplementation on platelet function: a randomized pair-matched, placebo-controlled, double-blind trial in men with low antioxidant status. Am J Clin Nutr. 1991;53:1222-1229.

(27.) Rath M. Health for the 21 Century. Cellular Health Series. 2001

(28.) Journal of Orthomolecular Medicine. 1992; 7:153-162.

(29.) Rath M. The Heart. Cellular Health Series.2001

(30.) Evans J. The Whole Pregnancy Handbook. New York: Gotham Books; 2005.

(31.) Block G. Use patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study. Nutr J. October 24, 2007; 6:30.

(35.) Assessing the efficacy and safety of medical technologies. Us Congress Office of Technology Assessment. September 1978. http://www.fas.org/ota/reports/7805.pdf.

(33.) The quality of medical care: information for consumers. US Congress Office of Technology Assessment. June 1988. http://www.princeton.ddu/-ota/ns20/year f.html.

(34.) Grimes D. Technology follies. JAMA. 1993;269(23):3030-3033.

(35.) Smith R. Where is the wisdom ...? Br med J. 1991;303:798-799.

(36.) Lila MA. The nature-nurture debate on bioactive phytochemicals: the genome versus terroir. J Sci Food and Agri 2006;86:2510-2515.

(37.) Duckett SK, Wagner DG, et al. Effects of time on feed on beef nutrient composition. J Anim Sci. 1993;71(8):2079-2088.

(38.) Dhiman TR, Anand GR et al. Conjugated linoleic acid content of milk from cows fed different diets. J Dairy Sci. 1999;82(10):2146-2156.

(39.) World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, physical Activity, and the Prevention of Caner: a Global Perspective Washington, DC: AICR, 2007

(40.) Hermansen K. Diet, blood pressure and hypertension Br J Nutr 2000:83(suppl).

(41.) Massey Lk. Dairy food consumption and stroke. J Nutr. 2001;131:1875-1878.

(42.) Weston price Foundation. http://www.westonaprice.org/splash2.htm.

(43.)Lee J, Hanley J, Hopkins V. What You Doctor May Not Tell You About Premenopause. Wamer Books; 1999.

(44.) Kushi LH,Byers T, Doyle C, et al. 2006 Nutrition and physical Activity Guidelines Advisory Committee.

(45.) World Cancer Research Fund International/American Institute for cancer Research. Food, 2007.

(46.) Hyman M. The life cycles of women: restoring balance. Altern Ther Health Med. 2007;13(3):10-16.

(47.) Puotinen CJ. Preventing eclampsia (metabolic toxemia of late pregnancy): an interview with patients. November 2004;256:69-76.

(48.) Jenkins DJ, Kendall CW, Marchie A, et al. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr. 2005;81(2):380-387.

(49.) Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun; 85(6):1586-1591.

(50.) Fan S, Meng Q, Auborn K,Crater T, Rosen EM. BRCA1 and BRCA2 as molecular targets for phytochemicals indole-3-carbinol and gentstein in breast and prostate cancer cells. Br J Canc. 2006;94:407-426.

(51.) Bell MC, Crowley-Nowick P, Bradlow HL, et al. Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecol Oncol. 2000 Aug;78(2):123-129.

(52.) Snow RR, Barbieri RL, Frisch RE. Estrogen 2-hydroxylase oxidation and menstrual function among elite oarswomen. J Clin Endocrinol Metab. 1991;69:369-376.

(53.) Auborn KJ. Can indole-3-carbinol-induced changes in cervical intraepithelial neoplasia be extrapolated to other food components? Nutr. October 2006;136:2676S-2678S.

(54.) Integrative Medicine Communications. Professional Guide to Conditions, Herbs & Supplements. Integrative Medicine Communications;2000.

(55.) Whitney E, Cataldo C, Rolfes S, Understanding Normal and Clinical Nutrition. St. Paul, MN: West publishing Company;1987.

(56.) Bendich A, Deckelbaum R, eds. prevention Nutrition: The Comprehensive Guide for Health Professionals, Totowa, NJ: Humana press; 1997.

(57.) Hernandez BY, McDuffie K, Wilkens LR, Kamemoto L, Goodman MT. Diet and premalignant lesions of the cervix: evidence of a protective role for folate, riboflavin, thiamin, B12. Cancer Causes and Control. 2003;14:859-870.

(58.) Palan P, et al. Plasma levels of beta-carotene, lycopene, canthaxanthin, retinol, and alpha and gamma-tocopherol in Clinical Cancer Research. 1996;2:181-185.

(59.) Lafiura KM, Bielawski DM, posecion NC Jr, et al. Association between prenatal pesticide exposures and the generation of leukemia-associated T(8;21). Pediatr Blood Cancer. 2007;49(5):624-628.

(60.) Ames B. The metabolic tune-up: metabolic harmony and disease prevention J Nutr. 2003;133:1544S.

[ILLUSTRATION OMITTED]

Cindy A. Krueger, MPH, has over 25 years' experience in the health care industry. As president of Preservion, Inc., the major focus of her professional life has been designing preventive health-care initiatives and strategies, advising individuals and companies on health-care options, researching and evaluating scientific literature to obtain accurate information, and writing articles and books.

Cindy is a popular speaker for her common-sense views on current health-care issues and economics. In addition to lecturing at professional conferences and organizations, she regularly appears on radio and TV shows around the country, sharing information that empowers consumers about the science supporting integrative and wholistic healthcare.

Cindy is the author of "Do You Know What You Don't Know ... About Women's Health lssues?" which also keeps her busy with lectures and book-signings throughout the country.

She holds a bachelor of science degree in physical education and health from the University of Southern Mississippi and a masters of public health degree from the University of South Florida.

Learn more about Cindy and her work at http://www.preservion.com.

by Cindy A. Krueger, MPH