A swab of vinegar and a lamp is all that’s needed to perform cervical cancer screening, according to a 15-year study in India that found the low-cost alternative to Pap smears can save lives.
The vinegar-based screening approach lowered cervical cancer death rates among Indian women 30 percent, researchers found. The study presented at the American Society of Clinical Oncology’s annual meeting in Chicago included 150,000 women.
While the Pap smear has reduced deaths from cervical cancer by 80 percent in the U.S. and other developed nations, the disease is the second most-common malignancy in less-developed regions in the world after breast cancer, according to the World Health Organization. Screening with vinegar doesn’t require specialized laboratory equipment, making it cheaper and more accessible in places where health-care infrastructure is poor.
“This is great news for developing countries, that you can use simple, inexpensive technology and prevent thousands of deaths,” said Carol Aghajanian, the chief of gynecological medical oncology at Memorial Sloan-Kettering Cancer Center in New York. She wasn’t involved in the study. “It’s inexpensive, it’s simple, and it allows for immediate action.”
Immediacy is important because many women have to travel far in order to seek medical care, Aghajanian said. Pap smears don’t provide instant results, and in the week it can take to get findings, women are lost to follow-up.
“It’s not just cost, it’s the repeated visits,” she said. “With Pap smears, you need further follow-up, and that’s a huge problem when you lack infrastructure. You may not find that woman again.”
Half of the women in the study received the vinegar screening, and half got no screening, which is the current standard of care in India, the authors said. The incidence of cancer was similar between the two groups, with about 27 cancers for every 100,000 women in the screening group and 28 cancers for every 100,000 in the non-screening group. That meant that the screening didn’t lead to over-diagnosis, researchers said.
Pap smears work by scraping skin off the cervix and examining it with a microscope, or doing a DNA test.
With vinegar, the test is done by applying it to a cotton swab and brushing it onto the cervix. After 60 seconds, normal tissue stays the same color, and cancerous tissue turns white. This can be seen using a lamp. Because the results are known immediately, this also provides an advantage to rural women who may have to travel to seek further care.
About 11 percent of patients in the vinegar screening group died from cervical cancer during the trial, compared with 16 percent who weren’t screened, according to the study.
When the study began in 1996, the Indian Council of Medical Research found it wouldn’t be feasible to screen a quarter of the population even if the existing Pap facilities were multiplied 12-fold. The study, by researchers from Tata Memorial Center in Mumbai, was supported in part by the U.S. National Institutes of Health.
The vinegar strategy may aid many low-income women. The screenings can be done by primary care workers, which further lowers the cost. Last year, the Geneva-based WHO reported that vinegar screenings had been successfully implemented in six African countries, and made recommendations for more widespread use of the practice, saying it’s safe and simple for women in poor nations.