A Breakthrough in Cervical Cancer Detection

A cheap method to detect cervical cancer using vinegar and a halogen lamp could cut down the deaths in the developing world by 35%, according to an article published in the medical journal The Lancet.

Cervical cancer, caused by the Human papilloma virus, is a malignant cancer of the cervix. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages. More than 250,000 women worldwide die from cervical cancer each year, with almost 80% of fatalities occurring in the developing world.

As of now, cervical cancer is detected by recovering cervical cells via a Pap smear which involves scraping cells from the cervix to be examined under a microscope in a laboratory. However, due to cost limitations, it is not readily available in developing countries.

The new method that has been reported is called visual inspection using acetic acid, or VIA. It involves the application of 4% acetic acid (a chemical compound present in vinegar) to the cervix. On close examination under a bright halogen focus lamp, the appearance of acetowhite lesions close to the squamocolumnar junction of the cervix indicate a positive VIA result.

This report is based on a 7 year study conducted on a group of healthy women aged 30-59 in the Dindigul district of Tamil Nadu, India. 49311 women were screened for cervical cancer using this method, while a group of 30958 women formed the control group.

It was found that almost 10 % (3088) women gave a positive VIA result. For a closer examination of the cervical tissue, 3052 of them were made to undergo colposcopy and 2539 directed biopsy. A total of 1874 were found to have precancerous lesions and were given immediate treatment, which involved freezing the affected area to destroy the abnormal tissue.

In the screened group, a total of 167 cervical cancer cases and 83 cervical cancer deaths were recorded while 158 cases and 92 deaths were reported in the control group. This equated to a 25% lower incidence rate and a 35% lower death rate in the screened group, compared with the control group.

This simple technique has been devised by an Indian doctor R Sankarnaryanan, now the Screening Group Head at International Agency for Research on Cancer (IARC) in France.

The test has, thus, been found to be a simple, feasible and effective method for prevention of cervical cancer in the developing countries and pilot projects have already been initiated in some of the Asian and African countries.

The sensitivity and specificity the test can further be improved using Lugol’s iodine staining, according to Dr Anne Szarewski, Wolfson Institute of Preventative Medicine, London.

She further added, HPV vaccines will probably offer the greatest hope for cervical cancer prevention in the long run.

Harshad Sanghvi, the medical director at Johns Hopkins University's programme for international education in gynaecology and obstetrics in the US called the study "a landmark" in the global fight against cervical cancer.

However, the test has also been found to have some limitations: It is not suitable for all women as pre-cancerous lesions in post-menopausal women, or those who have had more than two children, develop in parts of the cervix not normally visible.