This article is more than 5 years old. Information may no longer be current.
Vinegar screening technique reduced cervical cancer mortality by 31% in India
Click Here to Manage Email Alerts
CHICAGO — Biennial screening with acetic acid, or vinegar, reduced mortality from cervical cancer by 31% among women in India, according to study results presented at the ASCO Annual Meeting.
Researchers estimate this technique may prevent 22,000 cervical cancer deaths every year in India and nearly 73,000 deaths annually across resource-limited countries worldwide.
Country-wide Pap screening is not permitted in India due to lack of trained health care personnel, an inadequate infrastructure and the high-cost of screening.
Previous research indicated visual inspection with acetic acid (VIA) — the application of vinegar to the cervix with a cotton swab — may be a reasonable screening method due to its low cost and ease of use.
One minute after vinegar is applied to the cervix, health care workers conduct a visual inspection aided by a lamp. Pre-cancerous tissue turns white when the vinegar is applied, so results are known immediately.
Surendra Srinivas Shastri, MD, professor of preventive oncology at Tata Memorial Hospital in Mumbai, and colleagues recruited a group of primary health care workers to identify women in India aged 35 to 64 years with no prior history of cancer.
The analysis included 150,000 women who were randomly assigned to screening with biennial VIA (n=75,360) or no screening (n=76,178).
In the screening group, women were assigned four rounds of VIA and cancer education at 2-year intervals between 1998 and 2010. Women assigned to the no-screening group were assigned to one round of cancer education at baseline. They then were asked to report any clinical signs and symptoms of cervical cancer to their primary health care professional based upon what they learned during the initial cancer education sessions. Patients who reported signs or symptoms were then directed to Tata Memorial Hospital or another nearby facility of their choice.
All participants who were diagnosed with cervical cancer were offered free treatment.
Researchers observed a 31% decrease in cervical cancer-specific mortality with the VIA screening method (11.1 per 100,000 vs. 16.2 per 100,000; P=.003). In addition, there was a 7% decrease in overall mortality (P=.41), as cervical cancer was diagnosed at an earlier stage.
Similarities were observed in invasive cervical cancer incidence between the screening and no-screening groups (26.7 per 100,000 vs. 27.5 per 100,000).
“While overdiagnosis is normally a huge problem across trials, there were almost zero cases of over diagnosis in this study,” Shastri said.
“Our trial used primary health care workers who can easily access women in the community, which is critical in India and other countries that lack sufficient nurses, physicians and laboratory facilities,” Shastri added. “We are already working with state and national health authorities in India to make this screening strategy and health education available to women throughout the country.”
For more information:
Shastri SS. Abstract #2. Presented at: ASCO Annual Meeting; May 31-June 4, 2013; Chicago.
Disclosure: The researchers report no relevant financial disclosures. The trial was funded through a grant from the NIH.
Perspective
Back to Top
Nefertiti C. duPont, MD, MPH
The incidence of cervical cancer is low in the United States, but worldwide approximately 500,000 women will be affected with this disease. This disease is especially prevalent in India, where it is the leading cause of death in women. Shastri and colleagues were able to show a 31% decrease in cervical cancer mortality and a 7% decrease in all-cause mortality by a visual cervical inspection method using acetic acid. Pap smear screening is not widely available in Mumbai, so primary health workers were educated on how to evaluate the cervix using acetic acid. This simple, inexpensive method was effective in a population of women who are at high risk for cervical cancer and could be adopted worldwide in countries with high rates of cervical cancer.
Perspective
Back to Top
Maurie Markman, MD
It would not be an exaggeration to clearly state that this study conducted in Mumbai is one of the most important clinical research efforts in the management of female pelvic malignancies over the past several decades. From the truly impressive and innovative study design, the dedication of the research team, the commitment of the community and the impact of the outcome, this monumental effort should be applauded and the results seriously considered as a strategy to decrease cervical cancer mortality in the developing world.
Perspective
Back to TopJyoti D. Patel, MD, FACP
This study has tremendous implications for women around the world who have inadequate access to health care. Utilizing primary care health care workers to detect curable cancer saves lives and this is easily implementable.
Perspective
Back to TopElectra D. Paskett, PhD
How reliable was the VIA screening method vs. Pap smear? The accuracy is comparable. It’s very important to keep in mind that, in these resource-limited countries, this is now shown to be a good alternative.
Click Here to Manage Email Alerts