A SIMPLE vinegar test has slashed cervical cancer death rates by one-third in a remarkable study of 150,000 women in the slums of India, where the disease is a major killer.
Doctors reported the results yesterday at a cancer conference in Chicago. Experts called the outcome “amazing” and said the quick, cheap test could save tens of thousands of lives each year in developing countries by spotting early signs of cancer.
Usha Devi, one of the women in the study, said it saved her life.
“Many women refused to get screened. Some of them died of cancer later,” she said. “Now I feel everyone should get tested. I got my life back because of these tests.”
Pap smears and tests for HPV, a virus that causes most cervical cancers, have slashed cases and deaths in the developed world. But poor countries can’t afford those screening tools.
The new study tried a test that costs very little and can be performed by people with just two weeks of training and no lab equipment. They swab the cervix with diluted vinegar, which can make abnormal cells briefly change colour. The low-tech visual examination could prevent 22,000 deaths in India and 72,600 worldwide each year, researchers estimate.
“We had a 31 per cent 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 story of research participant Usha Devi is not an unusual one. Despite having given birth to four children, she had never had a gynaecological exam. She had been bleeding heavily for several years, hoping patience and prayers would fix things.
One day she found a card from health workers trying to convince women to join the study.
Ms Devi is in her late 40s and like many poor Indians doesn’t know her date of birth. She learned she had advanced cervical cancer. The study paid for surgery to remove her uterus and cervix.
Starting in 1998, researchers enrolled 75,360 women to be screened every two years with the vinegar test. Another 76,178 women were chosen for a control group that received cancer education at the start of the study and vouchers for a free Pap test – if they could get to the hospital to have one. Women in either group found to have cancer were offered free treatment at the hospital.
The free cancer screening was a hard sell in a deeply conservative country where women are subservient and need permission from husbands, fathers or others for even routine decisions. Social workers were sent into the slums to win people over.
“We went to every single house in the neighbourhood assigned to us introducing ourselves and asking them to come to our health talks,” said one social worker, Vaishnavi Bhagat. “The women were both scared and shy.”
One woman who did agree to testing jumped up from the table when she was examined with a speculum.
“She started screaming that we had stolen her kidney,” Ms Bhagat said. Another health worker was beaten by people in the neighbourhood when women realised they would have to undress to be screened.