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A Test with Vinegar May Do for Poor Countries What the Pap Smear Did for Rich OnesDiti Aloba ran out of the examination room shouting "It's OK! It's OK!" The twenty-seven year-old resident of Pasay City in the Philippines had just been informed that she did not have cervical cancer, after the nurse had run an innovative test with an everyday ingredient found all over the developing world—household vinegar. And had the test been positive, she would have been treated with a metal probe chilled in dry ice, available from any Coca Cola bottling plant.
Cervical Cancer Remains a Leading Cause of Death of Women in the Developing WorldEvery year in the United States about 7 women per 100,000 are diagnosed with cervical cancer. Every year in parts of Africa and South America, 53 women per 100,000 are diagnosed with cervical cancer. Cervical cancer rates have been declining for decades in the US and Europe, but are still climbing in most of the developing world.
All over the world, women of African and Hispanic descent are at special risk for cervical cancer, probably because of the prevalence of genes that make their bodies less sensitive to the effects of B vitamins. Even with the best diet, these women remain at greater risk for cervical cancer, but over 90% of women can be treated if the cancer is caught before it has spread.
Why the Pap Smear Is Not Available in the Third World
North American and European women have easy access to the Papanicolaou test, also known as a Pap smear. To do a Pap smear, the physician uses a device known as a speculum to open the cervix for visual inspection. The speculum collects cells from the cervix to be examined under a microscope for pre-cancerous changes.
Most often the Papanicolaou test detects changes in cells caused by exposure to the human papillomavirus (HPV), long before actual cancers emerge. If there are signs of cancer in the tissue sample, the woman is scheduled for colposcopy, which is a procedure using a lighted binocular microscope to examine the surface of the vulva, vagina, and cervix.
The area is swabbed with a 3% solution of acetic acid. Patches of tissue that have greater rates of DNA activity appear white. The doctor removes samples from the white-stained tissue for biopsy. Then if the biopsy shows pre-cancerous changes, appropriate treatments are offered.
In most of the Third World, this level of examination simply is not possible. There are no labs for reviewing Pap smears, and no microscopes for colposcopy. Or the pathology labs may do good work, but medical workers have no way of contacting women when they get their test results.
Before the 1990's, it simply was not possible to detect cervical cancer until it had begun to cause obvious symptoms such as constipation, blood in the urine, swelling in the legs, and hydronephrosis, the backing up of urine into the bladder. Many women died of cervical cancer not detected until it was too late for treatment. But the invention of the acetic acid method has begun to result in drastic reductions in cervical cancer rates in the countries where it is used most, especially Thailand.