Peru tries vinegar against cervical cancer

Women in the isolated Amazon jungle region of San Martín in Peru are participating in a research programme to prevent cervical cancer, which kills an unusually large number of women in that country — some 40 per 100000 women per year compared to just over 9 per 100000 per year in North America, according to figures from WHO's International Agency for Research on Cancer.

Under the programme the women in San Martín, many of them small farmers who live far from the nearest health post, are being diagnosed and treated for precancerous lesions in one visit, rather than having to return at a later time to learn the results of the usual Pap smear test. Before the programme began, only 23% of the women with abnormal Pap smear tests had received follow–up treatment in San Martín, according to a survey done before the screening and treatment programme began.

The programme is sponsored by the Pan American Health Organization and the national and departmental health ministries, with financing from the Bill and Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention.

Midwives are being trained to perform a gynaecological examination and screen women with an experimental method known as Visual Inspection with Acetic Acid (VIA), that is, vinegar. Application of the vinegar causes suspicious lesions to appear white with clear borders.

If such a lesion shows up, a physician performs a second VIA test under magnification. If the existence of abnormal cells is confirmed, the women are offered a biopsy and immediate treatment with cryotherapy, the freezing of the lesions.

A research study conducted on women aged between 25 and 55 years in Zimbabwe and published in The Lancet (1999;353:869–73) showed that the VIA screening method detected ''about 77% of all abnormal tissue, about the same rate achieved with Pap smears according to Silvia Robles, programme coordinator for noncommunicable diseases at the Pan American Health Organization (PAHO) in Washington. Robles told the Bulletin the number of false positives is somewhat higher than with a Pap smear, which has a relatively low sensitivity. She added that a false positive is better than a false negative in these cases.

Robles said the programme in Peru is designed to determine if this screening and treatment method will work under ''real life conditions'' in developing countries, where transportation is difficult, money for expensive equipment is scarce, and there are frequent changes of government.

More than 160 community leaders and government workers have been trained to teach women about cervical cancer and encourage them to participate in the programme. The equipment used is portable and the health workers can take it by river to women who live far from the nearest health post.

Since the women can be treated the same day they are screened, it is expected that more women will get treatment than would have if they had to return to the health post to learn the results of a Pap smear. Marie Andrée Diouf, Director of PAHO in Peru, said the programme, which began in 2000, is already a success. ''It is saving many women's lives,'' she said.

In Geneva Sonia Pagliusi of the WHO Initiative for Vaccine Research told the Bulletin she considered VIA to be ''a new method still under evaluation — it's in the research stage in India, comparing different methodologies. It's promising but not yet proven. WHO has no formal recommendation to use it.''

Terri Shaw, Lima

World Health Organization Genebra - Genebra - Switzerland