Vinegar screening helps cut cervical cancer deaths in India
June 03, 2013 - A simple screening program for cervical cancer using vinegar and
visual exams helped reduce deaths caused by the cancer by 31 percent in a group of
150,000 poor women in India, researchers reported on Sunday. If implemented broadly,
the screening program could lead to the prevention of 22,000 deaths from cervical
cancer in India, and 72,000 deaths in the developing world each year, the team reported
at the American Society of Clinical Oncology meeting in Chicago, the United States.
"We had a 31 percent reduction in cervical cancer death. That was very significant,"
said Dr Surendra Shastri of Tata Memorial Hospital in Mumbai, India, who led the study
and presented the findings at the meeting. The study also showed a 7 percent reduction
in deaths from any cause, although that finding was not statistically significant.
Cervical cancer is the leading cause of cancer deaths among women in India and in
many parts of the developing world. "Low-cost screening programs such as described
in India are desperately needed," said Dr Kathleen Schmeler of the University of Texas
MD Anderson Cancer Center in Houston. Shastri said currently there are no cervical
cancer screening programs in India, mainly because PAP smear screening, the conventional
test done among women in developed countries, is not possible because of issues such
as logistics, infrastructure and high costs. "We hope our results will have a profound
effect in reducing the burden of cervical cancer in India and around the world," Shastri
said. The study involved women selected from 20 slums in the city of Mumbai. To overcome
some of the social barriers of screening, the team first met with religious, political
and community leaders to gain support for the program. For the screening program,
the team trained young women with at least a 10th grade education on how to apply
the vinegar solution and evaluate the results. As a result of these efforts, "the
screening participation rates were 89 percent, huge for a country like India," Shastri
told the briefing. The study involved women aged 35 to 64 with no previous history
of cancer. They were randomly assigned to either an education program to teach women
how to recognize symptoms of cervical cancer or a screening program in which a vinegar
solution is applied to the cervix, which can make pre-cancerous tissues turn white
and visible to the naked eye after only a minute. The screening group got four rounds
of this vinegar treatment and visual inspection plus cancer education every two years.
All of the women in the study were offered treatment for their cervical cancers. Among
women in the screening group, there was a 31 percent reduction in cervical cancer
deaths compared with women in the education-only group. Based on the study results,
Shastri said the Indian government plans to take up the screening program on a population
basis. In the state of Maharashtra, where the trial was done, health officials are
preparing to train primary health care workers to provide the screening to all women
in the state aged 35-64, including women who took part in the control arm of the study
who did not receive screening. Doctors at the meeting said the program could offer
a good alternative to PAP testing. "What we're talking about is the use of vinegar
in a large screening program where PAP testing is not available. There have been studies
that have demonstrated that the accuracy of theseprograms is comparable," said Electra
Paskett, an ASCO spokeswoman and an expert in gynecologic cancers at the Ohio State
University Comprehensive Cancer Center. Dr. Monique Spillman of the University of
Colorado Cancer Center, said similar efforts have been tried in parts of Africa.
"This quick and cheap procedure could identify women who need to see a physician for
treatment of cervical pre-cancer or cancer, while reassuring women who have normal
results," she said. Schmeler of MD Anderson is conducting similar studies in Brazil
and El Salvador using the vinegar technique in combination with testing for human
papillomavirus or HPV, the virus that causes cervical cancer, to try to improve on
the accuracy of such screening programs, which can sometimes result in overtreatment.
"The work we're doing is to try to go to the next step to determine who are the false
positives," Schmeler said. (Source: Reuters)