A SIMPLE vinegar test slashed cervical cancer death rates by one-third in a remarkable study of 150,000 women in the slums of India, where the disease is the top cancer killer of women.
Experts called the outcome "amazing" and said this quick, cheap test could save tens of thousands of lives each year in developing countries by spotting early signs of cancer.
Usha Devi, one of the women in the study, says it saved her life.
"Many women refused to get screened. Some of them died of cancer later," Ms Devi said. "Now I feel everyone should get tested. I got my life back because of these tests."
Cervical smears and tests for HPV, a virus that causes most cervical cancers, have slashed cases and deaths in the western world. But poor countries can't afford those screening tools.
This study tried a test that costs very little and can be done by local people with just two weeks of training. They swab the cervix with diluted vinegar, which makes abnormal cells change colour.
This low-tech visual exam cut the cervical cancer death rate by 31pc, the study found. It could prevent 22,000 deaths in India and 72,600 worldwide each year, researchers estimate.
"That's amazing. That's remarkable. It's a very exciting result," said Dr Ted Trimble of the National Cancer Institute in the US, the main sponsor of the study.
The story of research participant Usha Devi is not an unusual one. Despite having given birth to four children, she had never had a gynaecological exam. She had been bleeding heavily for several years, hoping patience and prayers would fix things.
"Everyone said it would go away, and every time I thought about going to the doctor there was either no money or something else would come up," she said.
One day she found a card from health workers trying to convince women to join the study. She learned she had advanced cervical cancer.
The study paid for surgery to remove her uterus and cervix.
The research effort was led by Dr Surendra Shastri of Tata Memorial Hospital in Mumbai. India has nearly one-third of the world's cases of cervical cancer – more than 140,000 each year.
"It's just not possible to provide smear screening in developing countries.
"We don't have that kind of money or the staff or equipment, so a simpler method had to be found," Dr Shastri said.
Starting in 1998, researchers enrolled 75,360 women to be screened every two years with vinegar tests.
Another 76,178 women were chosen for a control, or comparison group that just got cancer education at the start of the study and vouchers for a free smear test – if they could get to the hospital to have one. Women in either group found to have cancer were offered free treatment at the hospital.
"We went to every single house in the neighbourhood assigned to us introducing ourselves and asking them to come to our health talks.
"They used to come out of curiosity, listen to the talk but when we asked them to get screened they would totally refuse," said one social worker, Vaishnavi Bhagat. "The women were both scared and shy."
The study was planned for 16 years, but results at 12 years showed lives were saved with the screening. So independent monitors advised offering it to women in the control group.