Wider Use of Cervical Screening Could Save Lives

An easy, inexpensive method that uses ordinary vinegar to screen women for cervical cancer could, if used more widely, increase the number of women whose disease is caught early and treated.

The findings were reported in an English language article in the January 2005 issue of the Pan American Journal of Public Health. The screening method—known as visual inspection with acetic acid, or VIA—has been recommended for use in low-resource settings but could help save women’s lives if it were more aggressively promoted as an alternative or supplement to the Papanicolaou smear, or Pap smear, according to the study.

Cervical cancer is the second most common form of cancer in women after breast cancer. It is caused by a sexually transmitted virus, human papilloma virus, which causes lesions on the cervix that, if left untreated, can develop into cancer.

Largely as a result of widespread screening with Pap smears, cervical cancer incidence and mortality rates have declined steeply in North America, to below 10 per 100,000 women in Canada and the United States. However, rates in most Latin American and Caribbean countries remain above 20 per 100,000 (in many cases, much higher) and are surpassed only by rates in East Africa and Melanesia.

In this context, VIA has been developed as an alternative to the more complex and expensive Pap smear in developing countries. The method involves washing the cervix with vinegar for one minute, after which the health worker performs a naked-eye observation of the cervix to see whether the epithelium, a protective tissue layer, turns white. This would indicate precancerous lesions.

Unlike a Pap smear, which requires laboratory processing, VIA yields immediate results. If the findings are abnormal, women receive special counseling about the results and about the importance of returning a week later for confirmatory studies with colposcopy and biopsy.

In contrast, women who receive Pap smears must return to the clinic to learn their results. Because many never do, many are never informed that they need treatment.

The Journal study involved 1,921 women and was carried out at the Peruvian Cancer Institute (Instituto de Enfermedades Neoplásicas) in 1999 and 2000. Its principal author, José Jeronimo, is a Peruvian physician who works at the Division of Cancer Epidemiology and Genetics at the U.S. National Institutes of Health’s National Cancer Institute.

Examining both VIA and Pap smear screening, Jeronimo et al. found that VIA increases detection of pre-malignant lesions on the cervix.

Moreover, while 26 percent of women who had positive Pap smears failed to return for follow-up, only 3 percent of the VIA-positive women failed to return. VIA thus "diminishes the probability of losing women before they are appropriately followed up and treated," said the article.

The study concludes that VIA should be promoted as a screening method in developing countries, but not just in low-resource settings where medical personnel have limited training and medical equipment is not necessarily up to date. VIA offers significant advantages even in settings with better-trained staff and more up-to-date medical equipment, the study says.

"VIA can be used as a screening tool in poor countries not only in rural areas and small health centers but also in hospitals, cancer institutes, and other health facilities with better resources."