Vinegar.  Amazing.

Vinegar Cancer Test Saves Lives

Mon, 06/03/2013 – 1:48pm

by  Associated Press, Marilynn Marchione, Muneeza Naqvi

A simple vinegar test 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 the top cancer killer of women.

Doctors reported the results at a cancer conference in Chicago.
Experts called the outcome "amazing" and says this quick, cheap test could save
tens of thousands of lives each year in developing countries by spotting early
signs of cancer, allowing treatment before it’s too late.

Usha Devi, one of the women in the study, says it saved her
life.

"Many women refused to get screened. Some of them died of cancer
later," Devi says. "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 U.S. But poor countries can’t
afford those screening tools.

This study tried a test that costs very little and can be done
by local people with just two weeks of training and no fancy lab equipment. They
swab the cervix with diluted vinegar, which can make abnormal cells briefly
change color.

This low-tech visual exam cut the cervical cancer death rate by
31 percent, the study found. It could prevent 22,000 deaths in India and 72,600
worldwide each year, researchers estimate.

"That’s amazing. That’s remarkable. It’s a very exciting
result," says Ted Trimble of the National Cancer Institute in the U.S., the main
sponsor of the study.

The story of research participant Usha Devi is not an unusual
one. Despite having given birth to four children, she had never had a
gynecological exam. She had been bleeding heavily for several years, hoping
patience and prayers would fix things.

"Everyone said it would go away, and every time I thought about
going to the doctor there was either no money or something else would come up,"
she says, sitting in a tiny room that serves as bedroom, kitchen, bathroom and
living room for her entire family.

One day she found a card from health workers trying to convince
women to join the study. 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.

The research effort was led by Surendra Shastri of Tata Memorial
Hospital in Mumbai. India has nearly one-third of the world’s cases of cervical
cancer — more than 140,000 each year.

"It’s just not possible to provide Pap smear screening in
developing countries. We don’t have that kind of money" or the staff or
equipment, so a simpler method had to be found, Shastri says.

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, or comparison group that just got 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.

Still, this quick and 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 neighborhood assigned to
us introducing ourselves and asking them to come to our health talks. They used
to come out of curiosity, listen to the talk but when we asked them to get
screened they would totally refuse," says 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," Bhagat says. Another health worker was beaten by people in the
neighborhood when women realized they would have to disrobe to be screened.

"There was a sense of shame about taking their clothes off. A
lot of them had their babies at home and had never been to a doctor," says one
health worker, Urmila Hadkar. "Sometimes just the idea of getting tested for
cancer scared them. They would start crying even before being tested."

But screening worked. The quality of screening by health workers
was comparable to that of an expert gynecologist, researchers reported. The
study was planned for 16 years, but results at 12 years showed lives were saved
with the screening. So independent monitors advised offering it to the women in
the comparison group.

An ethics controversy developed during the study. The U.S.
Office for Human Research Protections faulted researchers for not adequately
informing participants in the comparison group about Pap tests for screening. A
letter from the agency in March indicated officials seemed to accept many of the
remedies study leaders had implemented.

Others defended the study.

"We looked at the ethics very carefully" and felt them to be
sound, and visited the project in India, said Trimble of the National Cancer
Institute.

Sandra Swain, a cancer specialist at Medstar Washington Hospital
Center, also defended the research. She is president of the American Society of
Clinical Oncology, and the research results were presented at that group’s
meeting in Chicago.

"There really was no wrongdoing there," she says. "They have no
screening anyway," so there is no standard of care now.

Officials in India already are making plans to expand the
vinegar testing to a wider population.

Many poor countries can’t afford mammograms for breast cancer
screening either. The India study also has been testing breast exams by health
workers as an alternative. Preliminary results suggest breast cancers are being
found at an earlier stage, but it’s too soon to know if that will save lives
because not enough women have died yet to compare the groups, says Trimble of
the National Cancer Institute.

More progress against cervical cancer may come from last month’s
announcement that two companies will drastically lower prices on HPV vaccines
for poor countries. Pilot projects will begin in Asia and Africa; the campaign
aims to vaccinate more than 30 million girls in more than 40 countries by
2020.