Low tech but high benefit cervical cancer treatment

Household vinegar. Liquified carbon dioxide. Rural clinics. In Thailand, a successful procedure to screen for and treat cervical cancer demonstrates that innovative medicine need not always be at the cutting edge of technology.

A story in this week s New York Timesreports how a simple, inexpensive procedure known as VIA/cryo is making a significant difference in developing countries, where the majority of the world s cervical cancer cases now occur. VIA/cryo is the name for the diagnostic and therapeutic procedure that uses vinegar to identify abnormal areas in the cervix. The acetic acid in vinegar turns lesions white and guides the subsequent treatment: freezing the lesions for easy removal, called cryotherapy.

VIA/cryo was developed in the 1990s at the Johns Hopkins University School of Medicine by doctors whose work in low-income countries made them aware that techniques common in the Western world to screen for and treat cervical cancer were far too expensive to implement in developing countries. As an alternative to Pap smears and biopsies, these doctors determined that whitening precancerous cervical lesions with vinegar was an effective screening method; they then found that liquified CO2 was a readily available coolant (from soda bottlers!) that could be used to freeze off such lesions. And VIA/cryo actually reveals more abnormalities and pre-tumors than the typical Pap smear, with a 90 percent lesion removal efficacy rate that is actually less invasive than the Western norm of biopsy. (However, the screening method does produce a higher rate of false positives than a Pap smear.) Thailand s network of nurse-run rural clinics and its relatively educated population have made it an ideal location for implementing the procedure.

In the 11 years since the VIA/cryo procedure was brought to Thailand, it has gained wide acceptance. The procedure is now routine in 29 of the 75 provinces, and 500,000 of the country s 8 million women in the target population of ages 30 to 44 have been screened at least once. Because cervical cancer takes decades to develop, it s too early to tell whether Thailand has lowered its incidence; however, the results so far seem very promising, since none of the 6,000 women recruited 11 years ago for the first trial has developed full-blown cancer.

This is an impressive example of medical care making use of the resources at hand, ACSH s Dr. Gilbert Ross observes. Given that the prevalence of cervical cancer is so high in the less-developed regions of the world (85 percent of the more than 250,000 annual deaths due to the disease occur outside Europe and North America), we also hope that the vaccine protective against human papillomavirus (HPV) will soon join these extremely laudable methods of combating cervical cancer.