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Home News and Update Year 2010 Fighting Cervical Cancer with Vinegar, Iodine

Fighting Cervical Cancer with Vinegar, Iodine

Times of India
18 May 2010
By Pushpa Narayan
Chennai, India

Pilot Study Completed In Two Districts, State Plans To Expand Programme
Two years ago, when P Thilagammai was grieving the death of her 50–year–old mother, she did not know cervical cancer patients like her mother could have lived long if the disease was diagnosed early. Today, the 26–year–old works as a counsellor at the government hospital in Kambam in Theni district, helping young women detect cervical cancer at an early stage. Caused by the human papilloma virus, the cancer affected 132,000 Indian women and killed 74,000 of them last year. Women, especially those in rural areas, are most affected as the infection goes undiagnosed till it is too late.

Now, a detection method which is cheaper and faster than conventional Pap smear test is holding out promise to these women.

All it takes for detection using this method are some vinegar (acetic acid), Lugol’s iodine and cotton swabs. The tests, called the Visual Inspection with Acetic Acid (VIA) and Visual Inspection with Lugol’s Iodine (VILI), can easily replace Pap smear tests which requires elaborate laboratory tests. They were part of a three–year study completed recently by Tamil Nadu, based on an Italian method for early detection of the cancer.

The pilot study for early detection of cervical cancer was launched in Theni and Thanjavur districts by the state government in association with Tata Memorial Centre, Mumbai and Madurai Medical College in 2007. It has identified and treated 1,180 women with abnormal cervix in a population of nearly 4.87 lakh. While 887 were confirmed for cancer, more than 290 were picked up in the pre–cancer stages.“Timely intervention has prevented at least 25% of women from getting cancer. They are being regularly monitored.

In many others, we have improved survival rates because cancer was detected at an early stage,”says Dr Bharathi Balaiah, state coordinator for the cancer–cervix project.

Village link nurses apply vinegar with cotton swabs on a cleaned cervix. After a minute, any cancerous precancerous lesion would turn white, which is visible to the naked eye under a halogen lamp. The test is also repeated with Lugol’s iodine, a golden brown liquid. The colour changing to mustard could mean mustard–like conditions. If there is a colour change, the patient is sent for colposcopy (observation of cervix using a magnifier). In the last two years, Thilagammai has sent 350 women for colposcopy and more than 20 were positive cervical cancer.

In rural areas, the test is considered valuable for two reasons. First, its affordability when compared to the alternative Pap smear. While Pap smear test costs Rs 250 per person, the vinegar–iodine test can be done for less than Rs 50. Unlike for Pap smear test, we don’t need technical staff to take samples and test them. This is a visual test that can be done by any trained healthcare worker.

“It saved my life,”says 38–year–old Mariya Chinnadurai (name changed) who was found to have pre–cancerous lesions.“My sister died of the disease,”she says.

The study, monitored by the Indian Council of Medical Research, has been completed and researchers are now in the process of analysing data.“We do not have a complete picture yet, but it is fascinating enough to push for a state–wide policy,”said health secretary VK Subburaj.

State health systems project director S Vijayakumar said the health department would be extending the study to all districts after the results of the pilot are published.

Doctors agree it is a cost–effective way of screening, but they think it is not fool–proof.“We always follow it up with a biopsy because we know it can produce many false positives. For instance, in postmenopausal women or women who have had more than three children, pre–cancerous lesions develop in parts of the cervix not normally visible. But at least there is a screening and we know who is at risk and who has to undergo the test,”Dr Bharathi adds.

Early Remedies
Visual Inspection With Acetic acid (VIA) and Visual Inspection with Lugols Iodine (VILI) are being used for prevention and early detection of cervical cancer in rural areas

The Procedure
Uterus
The woman is made to lie down on her back with legs bent at the knees. After examining the external genital area, it is cleaned and then damped with acetic acid. After a minute the cervix is inspected again for abnormal changes. In pre–cancerous and cancerous condition the surface turns white. The same is repeated with lugols iodine. In precancerous and cancerous condition the surface turns mustard

Why VIA/VILI?
It is a quick method that efficiently picks up precancerous and cancerous lesions in the cervix IT’s Advantages Are

  • It does not require extensive training or any special equipment
  • It’s cost–friendly
Treatment
A gynaecologist inspecting a woman with the VIA and the VILI method A gynaecologist inspecting a woman with the VIA and the VILI method
After confirming with biopsy, patients with cancer are referred to a tertiary care center. A precancerous lesion, however, may be managed through cryo surgery –freezing the outer abnormal cells of the cervix. And patients are monitored

When was VIA First Established?
1982M Two Ottoviano Italian gynaecologists and P La Torre –established that the white changes induced by dilute acetic acid application on the cervix can be visualised by the naked eye

1993colleagues An Italian cytologist confirmed S that Cecchini vinegar and was as good as a PAP smear in detecting early pre–cancerous lesions

Earlier Trials In India
In the Regional Cancer Centre, Thiruvananthapuram between 1997 and 1999, initial studies were carried out to confirm these. Two years ago, researchers from TN, along with colleagues from the International Agency for Research on Cancer in France, published a study in Lancet that showed how visual screening revealed early signs of cervical cancer & reduced the number of cases by a quarter. The study done between 2000 and 2006 showed that there were 167 cases and 83 cervical cancer deaths in women who did screening, compared with 158 cases and 92 deaths in those who didn’t

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