CHICAGO―Simple vinegar (acetic acid)-based visual inspection screenings by primary paramedical health workers reduced cervical cancer mortality by 31% over 15 years, report authors of a large, randomized study of 150,000 women in India, presented at the 2013 American Society of Clinical Oncology (ASCO) Annual Meeting.
The low-cost screening alternative to Pap tests and HPV could prevent as many as 73,000 cervical cancer deaths worldwide each year, in low-income countries, reported Surendra Shastri, MD, of the Tata Memorial Center in Mumbai, India. The vinegar-based screenings allowed immediate visual identification of precancerous lesions in about 1 minute, Dr. Shastri reported.
The coauthors enrolled Indian women age 35-64 years with no cancer history, randomly assigning them to receive biennial visual inspections using 4% vinegar applied to the cervix (n=75,360 women) or to receive no screening, the current standard of care in India (n=76,178). The control group was briefly educated about cancer symptoms at enrollment.
The incidence of cervical cancer was similar between the two treatment groups (26.7 per 100,000 in the vinegar screening group and 27.5 per 100,000 among women in the control group).
“This suggests the screening did not lead to overdiagnosis,” Dr. Shastri noted.
But the screening group experienced a 31% reduction in cervical cancer-specific death rates (11.1 vs 16.2 per 100,000 women; mortality rate ratio [RR], 0.69; 95% CI: 0.54-0.88; P=0.003), he said. A 7% overall death rate reduction in the screening group did not achieve statistical significance, but was probably associated with the earlier detection of tumors in the screening group, Dr. Shastri said.
In high-income nations like the United States, Pap screening has reduced cervical cancer mortality by 80%, Dr. Shastri noted. But in India and other poor countries, inadequate infrastructure and trained health care work forces, logistic difficulties, and the relatively high cost of Pap and HPV-based cervical screening programs preclude their widespread implementation, he said.