Using Vinegar in the Fight Against Cervical Cancer

A Test with Vinegar May Do for Poor Countries What the Pap Smear Did for Rich Ones

Diti 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 World

Every 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.

READ Questions You Should Ask Your Ob-gyn

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.

Vinegar Better Than Pap Smear?

In the United States, doctors perform Pap smears to identify women who may need the acetic acid test on a future appointment to locate pre-cancerous lesions. In Thailand, nurses start with the acetic acid test and remove suspicious spots at the same visit. Since household vinegar is approximately 3% acetic acid, they do not need any special diagnostic supplies. If white spots are noticed, the nurse freezes them with a metal probe cooled with dry ice.
 

Medical workers do not have to wait weeks to get lab results, and they do not have to track down women who need follow-up care for potential cervical cancer. Everything is taken care of in a single visit without need for social workers or a sophisticated pathology lab. But those are not the only advantages of this simple medical procedure:

• The vinegar test is more accurate than a Pap smear, although more women who do not actually have pre-cancerous lesions of the cervix will test positive.
• There are no painful biopsies. If pre-cancer is suspected, the spot is removed.
• Recovery time is much shorter. Women experience minor discomfort for a day or two with the dry ice treatment, while they may have significant discomfort from colposcopy and follow-up treatment in a Western medical center.

READ The Ten Most Common Cervical Cancer Myths

In Roi Et province in Thailand, where Dr. Wachara Eamratsameekool helped pioneer the procedure, not a single woman of the 6,000 tested and found to have pre-cancerous changes of the cervix has gone to have cervical cancer. The test and treatment cost less than $5.

Can You Do This At Home?

In Thailand, nurses are given flash cards to help them memorize the appearance of treatable cervical conditions, and practice performing dry ice therapy on hot dogs placed inside pipes before going out to village clinics to treat real women. If the procedure is this simple, could anybody do it?

No woman is going to be able to use this technique on herself. And because the technique relies on visual inspection without magnification, the nurses who do the vinegar test will miss pre-cancerous lesions that are not large enough to see with the naked eye. Colposcopy catches pre-cancer at an earlier stage. There really are advantages of modern medicine—but the vinegar test followed by dry ice treatment is an enormous improvement over no treatment at all.

Would HPV Vaccine Make This Test Unnecessary?

Americans hear a great deal about HPV vaccination to prevent cervical cancer, especially since presidential candidate and Texas governor Rick Perry ordered HPV vaccinations for all Texas girls in middle school (after his former aide was paid $1.3 million by the vaccine makers). The Gardasil vaccine offers protection against four different strains of HPV, 6, 11, 16, and 18.

However, cervical cancer can also be caused by HPV strains 33, 45, 52, 53, and 65. Epidemiologists estimate that vaccinating 100% of girls before their first sexual experience would result in a 91% reduction in cervical cancer, due to the fact that many more strains of HPV also can cause cancer.

The good news from Thailand that applies to women all over the world is that the key to avoiding cervical cancer is not sophisticated laboratory diagnosis or HPV vaccination. It's follow-up. Women who get visible lesions treated in time don't get cancer. Don't delay the treatment you need.