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A simple, inexpensive method could be used to detect cervical cancer in countries where women do not have access to Pap smears or other screening programmes, say researchers.

The study — of 49,311 women between 30 and 59 years in Tamil Nadu in India — found that visual inspection of the cervix using acetic acid (VIA) is effective as a method of cervical cancer screening.

The findings were published in The Lancet on 4 August.

The group of women who underwent VIA had a 25 per cent reduction in cervical cancer incidence and a 35 per cent reduction in deaths compared with the control group, who received existing care.

The technique involves applying four per cent acetic acid (vinegar) to the uterine cervix and examining it with the naked eye under bright light. If a well-defined white area on the cervix is observed after one minute, the test is positive.

Women who were VIA-positive were offered immediate further treatment, including cryotherapy to remove any cancerous lesions, or a referral if they had suspected invasive cancer.

Rengaswamy Sankaranarayanan, of the France-based International Agency for Research on Cancer, who led the study, said the advantages of the technique were its simplicity and low cost.

The study authors conclude that, because screening over multiple visits is often not possible in developing countries, and vaccination against human papillomavirus is currently too expensive, "VIA screening, in the presence of good training and sustained quality assurance, is an effective method to prevent cervical cancer in developing countries", they write.

But gynacologic oncologist Elizabeth Vallikad, who leads a pilot cervical cancer screening programme in Karnataka in southern India, says that the success of the findings cannot be duplicated without extra staff. Her own efforts with existing staff have failed, she says.

Vallikad, from St John's Hospital in Bangalore, told SciDev.Net that the technique might have worked with the researchers because they had a dedicated staff, but the findings cannot be applied to conditions in a health clinic with no cervical cancer control programme or extra workers, she said.

She also questioned the effectiveness of vinegar and said fresh acetic acid is difficult to supply in rural settings.

The authors recommend that, to overcome problems of correctly applying the method and interpreting results, VIA should be routinely taught to health workers.

Link to full paper in The Lancet*

Reference: The Lancet 307, 398 (2007)

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