In this Tuesday, May 21, 2013 photo, Usha
Devi, right, who was suffering from cervical
cancer, talks with health workers from Tata
Memorial Hospital in a slum in Mumbai, India. 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.
Experts called the outcome amazing and said 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 its too late. Devi, one of the
women in the study, says it saved her life. (AP
Photo/Rafiq Maqbool)
MUMBAI, India – 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 Sunday at a
cancer conference in Chicago. Experts called
the outcome "amazing" and said 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 said.
"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 United
States. 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," said Dr. 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 said,
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 Dr.
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 said.
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," said 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 said. 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," said 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.
Dr. 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 on Sunday.
"There really was no wrongdoing there,"
she said. "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, said
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.
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