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Cover Story

The vinegar and iodine test

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A cup of vinegar, a tinge of iodine, a few cotton swabs and some bright light could be all that's needed to detect one of the worst killers of Indian women - cervical cancer. A three-year pilot study commissioned by Tamil Nadu in two of its districts (Theni and Thanjavur) and being readied for a review by the Indian Council of Medical Research (ICMR) has thrown up interesting results. During the tests, called the visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI), village link nurses were made to apply vinegar with cotton swabs on a cleaned cervix. They found that after just a minute, cancerous or pre-cancerous lesions would turn white and would be visible to the naked eye under a halogen lamp. The test would then be repeated with Lugol's iodine, a golden brown liquid: if the colour changed to mustard, it could mean cancer-like conditions. Caused by the human papilloma virus, cervical cancer last year affected more than 132, 000 Indian women and killed 74, 000 of them. Though the incidence of this cancer has gone down drastically in major cities and urban areas, it still tops the list as the most common cancer among women. "Such techniques would make prevention and early diagnosis easy, " says ICMR chief Dr VM Katoch. "Unlike the pap smear test, we don't need technical staff to take samples and test them. This is a visual test that can be done by any trained healthcare worker and requires just bright light. If the results show promise, we would recommend that it be taken up across the country to check cancer. " The study identified and treated 1, 180 women with abnormal cervix in a population of nearly 4. 87 lakh. While 887 were confirmed for cancer, more than 290 were picked up in the pre-cancer stages. "Timely intervention has prevented at least 25 per cent of women from getting cancer, " says Dr Bharathi Balaiah, state coordinator for the cancercervix project. What impressed policy makers even more was the cost factor. While a pap smear test costs Rs 250 per person, the vinegar-iodine test can be done for less than Rs 50. However, though doctors agree it is a cost-effective way of screening, they feel it is not foolproof. "We always follow it up with a biopsy, because we know it can produce many false positives. But at least there is a screening and we know who is at risk and who has to undergo the test, " Balaiah says.
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