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Vinegar screening helps cut cervical cancer deaths in India: study

By Julie Steenhuysen

CHICAGO (Reuters) - 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.

"We had a 31 percent reduction in cervical cancer death. That was very significant," 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 these programs 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.

(Editing by Doina Chiacu)

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