ASCO Annual Meeting
June 2, 2013
A large clinical study that followed 150,000 women in India over 15 years found that screening with visual inspection with acetic acid (VIA), or vinegar, every other year reduced the number of cervical cancer deaths by nearly one-third (31%). Cervical cancer is the leading cause of cancer death for women living in many developing countries where there is little or no access to Pap tests (a procedure in which the doctor gently scrapes the outside of the cervix and vagina to take samples of the cells for testing). The researchers estimated that easy, low-cost screening with VIA could prevent 22,000 cervical cancer deaths every year in India and close to 73,000 deaths in developing countries around the world.
In developed countries, screening for precancerous and cancerous cells using Pap tests has reduced cervical cancer development and death by 80%. However, in India and other developing countries, screening examinations like Pap tests and human papillomavirus (HPV) testing is not possible for most women, especially those living in rural areas, because of the cost, the need for a laboratory to get results, and a lack of trained health care workers. The VIA test, on the other hand, is performed by applying vinegar to the cervix using a cotton swab. After 60 seconds, the cervix is examined with the naked eye using a lamp. Precancerous tissue turns white when vinegar is applied, while healthy tissue does not change color. The results are known immediately, and the test can be done by primary health care workers (community-based, non-medical personnel who receive special training and provide basic health care services in areas where doctors and nurses are unavailable).
As part of this study, women between the ages of 35 and 64 who had never been diagnosed with any type of cancer either received VIA screening every other year or were asked to report any potential signs and symptoms of cervical cancer they were experiencing to health care workers, which is the type of care most women in India receive. (According to international clinical research standards, tests and procedures are normally compared with what is available to most people in the local area.) All of the women who participated in the study also learned about cervical cancer and prevention, including Pap tests.
Although the same number of women developed cervical cancer in both groups, 31% fewer women who were screened with VIA died from cervical cancer, most likely because precancerous or cancerous cells on the cervix were found earlier. Because of these results, Indian health officials in Maharashtra state, where the study was located, are preparing to provide VIA screening to all women between the ages of 35 and 64, including women who participated in the study. In addition, the Indian government is planning to start VIA screening programs across the country, as well as reach out to other developing countries to inform them of these results and offer training resources.
What this means for patients
“We hope our results will have a profound effect in reducing the burden of cervical cancer in India and around the world,” said lead study author Surendra Srinivas Shastri, MD, Professor of Preventive Oncology at Tata Memorial Hospital in Mumbai, India. “This is the first trial to identify a cervical cancer screening strategy that reduces mortality and can be implemented on a broad scale throughout India and in other developing countries. Our trial used primary health care workers who can easily access women in the community, which is critical in India and other countries that lack sufficient nurses, physicians, and laboratory facilities. We are already working with state and national health authorities in India to make this screening strategy and health education available to women throughout the country.”
Questions to Ask Your Doctor
- What cervical cancer screening tests are available to me?
- How often should I be screened for cervical cancer?
- Where can I receive cervical cancer screening? How far away is this location?
- When will I receive my results? Will I need to come in for another appointment?
- What is the cost of cervical cancer screening?
- If I cannot afford this screening test, is there another option we could consider that doesn't cost as much?
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