ASCO 2013-A CERVICAL CANCER SCREENING METHOD FOR POOR COUNTRIES 

CHICAGO -- Vinegar has been used for everything from cleaning refrigerators to taming food odors, and now this common kitchen staple may reduce cervical cancer deaths, researchers reported here.

In a 15-year randomized study of 150,000 women in India, biennial visual inspection with vinegar (acetic acid) reduced cervical cancer mortality by nearly one-third, reported Surendra Srinivas Shastri, MD, from the Tata Memorial Hospital in Mumbai, and colleagues at the American Society of Clinical Oncology.

Cervical cancer is one of the more common cancers among women in developing countries and it is the leading cause of cancer death in Indian women, the authors stated.

"Since cytology-based screening is not easily implementable in India, there is a need to evolve simpler alternatives," they added.

Women, ages 35 to 64 years, with no prior history of cancer were randomly assigned to biennial screening with vinegar (75,360 women) or no screening (76,178 women), which is the current standard of care in India. The study was conducted from 1998 to 2002 with 12 years of follow-up.

Vinegar screening is administered by primary health workers who used a cotton swab to apply acetic acid to the cervix. If the spot turns white within 60 seconds, it means there are pre-cancerous changes in the tissue.

The authors found that the incidence of invasive cervical cancer was 26.74 per 100,000 (95% CI 23.41-30.74) in the screening group versus 27.49 per 100,000 (95%CI 23.66-32.09) in the control group.

In addition, women in the screening group were 7% less likely to die from any cause compared with those in the control group, but the difference did not reach significance (mortality rate ratio=0.93, 95%CI 0.79-1.10, P=0.41).

The results of the screening studies were known immediately, a very important advantage in rural areas where women might otherwise have to travel for hours to see a doctor, Shastri said.

Previous studies have suggested visual inspection with vinegar is a reasonable alternative to Pap smears or HPV DNA testing for its low cost and ease of use, but it's been slow to catch on.

That may change with this study, Electra Paskett , PhD, of The Ohio State University in Columbus, told MedPage Today.

"Showing that a screening test reduces mortality is the gold standard, and that had not been done before. Now we have a large randomized trial in a low-resource country showing the vinegar test meets that standard," said Paskett, who will act as discussant when the study is presented later today.

The researchers estimated this strategy could prevent 22,000 cervical cancer deaths every year in India and close to 73,000 in resource-poor countries worldwide.