CHICAGO ― Simple vinegar (acetic acid)-based visual inspection screenings by primary paramedical health workers reduced cervical cancer mortality by 31% over 15 years, results of a large, randomized clinical trial indicate.

The low-cost screening alternative to the Pap smear and human papillomavirus DNA testing could prevent as many as 73,000 cervical cancer deaths worldwide each year in low-income countries, Surendra Shastri, MD, of the Tata Memorial Center in Mumbai, India reported at  American Society of Clinical Oncology (ASCO) 2013 meeting.

The vinegar-based screenings allows immediate visual identification of precancerous lesions in about 1 minute, according to Shastri, and costs less than $1 per patient compared with an average $15 per test for Pap smear or HPV DNA testing.

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The researchers enrolled 150,000 Indian women age 35-64 years with no cancer history, and randomly assigned them to receive biennial visual inspections using 4% vinegar applied to the cervix (n=75,360 women) or to receive no screening, the current standard of care in India (n=76,178).

The control group was briefly educated about cancer symptoms at enrollment. The study was conducted from 1998 to 2002 with 12 years of follow-up.

Cervical cancer incidence was similar between the two treatment groups (26.7 per 100,000 in the vinegar screening group and 27.5 per 100,000 among women in the control group), suggesting the screening did not lead to over diagnosis.

The screening group experienced a 31% reduction in cervical cancer-specific death rates (11.1 vs 16.2 per 100,000 women; mortality rate ratio [RR], 0.69; 95% CI: 0.54-0.88; P=0.003). A 7% overall death rate reduction in the screening group did not achieve statistical significance, but was probably associated with the earlier detection of tumors in the screening group, Shastri said.

In high-income nations like the United States, Pap screening has reduced cervical cancer mortality by 80%, but in India and other poor countries, inadequate infrastructure, logistic difficulties and the relatively high cost of Pap and HPV DNA cervical screening programs preclude widespread implementation.

“We now have a method which could in a very simple way reduce cervical cancer mortality in low-resource countries like India,”  Shastri said.


  1. Shastri SS et al. Abstract #2. “Effect of visual inspection with acetic acid (VIA) screening by primary health workers on cervical cancer mortality.” Presented at: ASCO 2013. May 31-June 4, 2013. Chicago.

This article originally appeared on Cancer Therapy Advisor