Monday January 6 2014

Using vinegar to test for cervical cancer

Women line-up for free cervical cancer

Women line-up for free cervical cancer screening during an open health camp. File photo 

By Carol Nambowa

Of all home remedies available, who could have guessed vinegar could save a life, and in this case a woman’s life? Not save her life by sprinkling a bit of it on her salad before she eats it, but by providing a cheaper test for cervical cancer than was previously available.

Although using vinegar to test for cervical cancer has been around for many years now, according to DrJuliet Birungi, an obstetrician/gynaecologist at Mulago National Referral Hospital, only a handful of women in Uganda know about it, or have been tested using the procedure.

Dr Martin Origa, a gynaecologist with the Uganda Cancer Institute (UCI), at Mulago hospital insists the test is referred to as acetic acid and not vinegar test. It is commonly known as Visual Inspection with Acetic acid (VIA).

How it works
From a bottle of vinegar in the supermarket, acetic acid makes up the highest percentage of the ingredient. Both doctors Birungi and Origa caution that vinegar in supermarkets is not advisable because its purity is questionable. “In hospital settings, we use acetic acid, however vinegar is used as a substitute,” explains Dr Birungi.

Before it is used to test for cervical cancer, acetic acid is diluted with distilled water to three to five per cent. Then the woman lies in a lithotomy position (on the back with her knees bent and thighs apart).

Using a speculum to open the vaginal walls, the medical personnel apply some of the diluted acetic acid to cotton wool, which is then applied to the cervix for one minute. The medical personnel then observe the cervix for changes in the cells.
“The medical personnel should be able to differentiate between normal and abnormal changes in the cervix,” says Dr Origa.

The normal cervix colour is pink, so the doctor or nurse will know when the cells in the cervix turn white to signal a positive test or remain pink for a negative result.

Dr Origa however explains not all abnormal changes mean that one has cancer because the changes can be as a result of other factors.
“These changes simply mean we should go ahead to conduct further tests,” he says.

If the VIA test is positive, colposcopy is performed.
“A colposcopy involves using a powerful lens to observe abnormal changes in the cervix. This procedure can be carried out by a gynaecologist,” states Dr Origa.

Once a colposcopy is done and the test is positive, a cervical biopsy is taken and tested to confirm whether the patient has cervical cancer or not.

Benefits over pap smear
Using acetic acid to test for cervical cancer comes with benefits of being relatively cheap. An acetic acid test is free of charge in government hospitals and in some private facilities.

“In some private health facilities however, a patient might be charged up to Shs20,000 for the test to cater for gloves, cotton and sterilising instruments,” states Dr Origa. On the other hand according to Dr Birungi, the pap smear tests ranges from Shs40,000 to Shs100,000, depending on the hospital where it is done.

Another advantage of VIA is that it can be done by a medical practitioner at the rank lower than that of a doctor.

“The VIA test can be carried out by a nurse or a midwife in a low resource centre,” states Dr Birungi. Since this test is easily accessible to the average Ugandan, more women can be tested for cervical cancer compared to previous tests that largely relied on pap smear. There are no instruments required for a VIA, unlike the pap smear test which requires a microscope.

Yet still, with the VIA test, one can get immediate results compared the
pap smear tests whose results are received after a week or two.
“Results from a pap smear take longer because they require the interpretation of a cytologist yet we do not have many of these in Uganda,” Dr Origa explains.

The disadvantages
Although the VIA test is comparable to a pap smear test, its specificity is lower than that of the pap smear test. “A VIA test cannot be fully relied on to treat cancer. It is not a confirmatory test,” states Dr Origa.
Dr Origa also points out that interpretation of the changes is not uniform. “What I see is not what you see,” he says implying that the medical personnel could misdiagnose the condition.
It is up to the person who is viewing the cervix for changes to refer the woman or not for further tests after the intial one has been undertaken.
Another shortcoming of the VIA, is that it requires the medical personnel to know how to prepare the acetic acid solution.

According to both gynecologists, side effects of the VIA test are extremely minimal except for a burning or tingling sensation which disappears shortly after application.

However, as countries like Uganda embrace the use of acetic acid to test for cervical cancer, it is projected thousands of women’s lives will be saved by early detection of abnormal changes in cells of the cervix.

Dr Birungi advises that cervical cancer can be prevented if women delay having sexual encounters or have a faithful partner instead of having multiple sexual partners.
Secondary prevention methods include screening for cervical cancer to detect early changes that can be prevented.
Tertiary prevention involves early diagnosis and treatment of cervical cancer.

Cervical cancer can be detected from changes in the cervical cells by conducting a pap smear test, VIA and undertaking the lugols iodine test.
Dr Birungi advises women to screen for cervical cancer regularly. “When the results from a cervical cancer test are negative, the woman should do another test after three years. However with the Human Immunodeficiency Virus (HIV), women should screen for cervical cancer annually,” explains Dr Birungi.

The common symptoms that indicate that one has cervical cancer include smelly virginal discharge, abnormal bleeding, bleeding after contact and pain during sexual intercourse.

However, in some cases, a person may not have any of the above symptoms.

Facts about cervical cancer

Cervical cancer is casued by the human papillomavirus (HPV). One can contract HPV through sexual contact with someone who has it. There are different types of HPV and not all types of HPV cause cervical cancer. One can have HPV for years without knowing it, and a woman can develop cervical cancer several years after contracting the virus.

According to Dr Birungi, when cervical cancer is detected when it is in the late stages, a person will require undergoing chemotherapy, radiotherapy and removal of the cervix and uterus.

Cervical cancer is the leading cause of gynecological cancer in Uganda with over 3,500 women diagnosed with the disease every year, according to health experts.

Because a person with cervical cancer may not show early symptoms until after several years, health officials advise women and girls to screen regularly as an effective preventive measure.

HPV Vaccine
The human papillomavirus (HPV) vaccines can also be used to prevent cervical cancer.

HPV is administered in a series of three shots over six months. Currently, the vaccine is being administered to young girls between the age of nine and 12.

According to Dr Martin Origa, a gynaecologist at the Uganda Cancer Institute, parents are responding to the call to screen and have their daughters vaccinated against the HPV virus.

He further explains that the vaccine is effective in women and young girls who are not sexually active yet.

However, for women who are already sexually active, Dr Oringa says the vaccine reduces their risk of contracting the HPV virus compared to women who are not vaccinated.

While there are different types of HPV, some strains lead to cervical cancer, others may cause genital warts while others do not cause any infections at all.

Pap smear
During a pap smear test for cervical cancer, a smear of tissue from the cervix is taken. This secretion from the cervix has cells in it, which are examined under a microscope for abnormal changes. Dr Martin Origa a gynaecologist says the results from these tests take a week or two before the patient receives them because they require the interpretation of a cytologist.

The advantage of this test, DrOriga says is its specificity. When the results are positive, chances are high the abnormal changes really exist. “If it detects abnormalities, you may be able to treat a patient,” states Dr Origa.