Swab of vinegar could provide test for cervical cancer; Hopkins study may help reduce a leading cause of death for poor women

THE BALTIMORE SUN

A swab of vinegar could provide a simple, inexpensive way to screen women for early signs of cervical cancer, the leading cause of cancer death among women in poor countries where Pap smears are not available.

Reporting on a study in Zimbabwe, doctors from the Johns Hopkins School of Medicine and the University of Zimbabwe said the test could lead thousands of women each year to life-saving treatments.

"This really offers the promise of prevention," said Dr. Paul D. Blumenthal, a Hopkins gynecologist who directed the study. "If you can just find the patients before they have cervical cancer you can virtually ensure that they will not die of cervical cancer."

In the study, nurse midwives wiped a patient's cervix with vinegar and waited to see if any area turned white, a change that often signals a pre-cancerous lesion or a malignancy. The technique is based on a long-time practice in the United States, in which gynecologists observing the cervix under magnification use acetic acid to confirm a positive Pap smear.

Acetic acid is the principal ingredient in vinegar. The study is described in this week's issue of The Lancet, a British journal.

Public health authorities say an inexpensive screening tool is urgently needed in parts of Africa, Asia and Latin America, where cervical cancer is the leading cancer killer among women. It causes about 200,000 deaths each year in those regions, compared with 5,000 deaths in the United States, where Pap smears are widely taken.

The disease often is caused by a sexually transmitted virus that produces genital warts, benign growths that can turn cancerous.

Midwives were able to detect more than three-quarters of the cancers among 11,000 women in the study. But they also turned up a large number of "false positives" -- results that seemed worrisome but actually were not. Improved training, said Blumenthal, could reduce this problem in the future.

"This is much less costly and less complex to implement, especially in places that don't have a lot of resources to spend on medical care," said Dr. Beverly Winikoff of the Population Council, a non-profit group devoted to reproductive health.

"Pap smears require someone to take the smear correctly and to send it to a lab in good condition. Then, the lab has to read it properly, find the woman and bring her back to get treatment. With this test, you know right away."

Even with improved detection, countries would still have to find ways to provide affordable treatment.

"That's our next challenge," said Blumenthal. "In this country, we can do radical surgery and radiation. But radical surgery is hard to come by in developing countries, and radiation is virtually nonexistent."

Pub Date: 3/12/99

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