Maurie Markman, MD; Robert Coleman, MD


June 10, 2013

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In This Article


Maurie Markman, MD: Hello. I am Maurie Markman, Senior Vice President for Clinical Affairs and National Director for Medical Oncology at Cancer Treatment Centers of America in Philadelphia, Pennsylvania. Welcome to this edition of Medscape Oncology Insights, coming to you from the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO®). Joining me is Dr. Robert Coleman, Professor and Vice Chair of Clinical Research, Department of Gynecologic Oncology and Reproductive Medicine, at the University of Texas MD Anderson Cancer Center in Houston.

Cervix Cancer and Another Use for Vinegar

Dr. Markman: This has been a most impressive meeting for gynecologic cancer research. Let's start with the clinical studies in cervix cancer. What a presentation about research being done in India.[1]

Robert L. Coleman, MD: Yes, it wasinspirational, a phenomenal testament to investigators embracing what their healthcare crises are, coming up with a strategy, enacting that strategy, and making a major difference in mortality rates. It was amazing.

Dr. Markman: Can you briefly describe 20 years of work?

Dr. Coleman: Cervix cancer is a major issue in many developing countries such as India, where they have more than 100,000 cases. It is a huge healthcare burden for them. A major issue, as it was for us many decades ago, is access to screening and the impact that screening could have. They conducted a clustered prospective randomized trial looking at using an agent that we normally use for colposcopy to assess for defects on the cervix using visual inspection with acetic acid.

Of the 150,000 women, half (75,000 patients) were assigned to each group. The investigators went into the villages, and half of the women were given an educational session and would go through 4 rounds of visual inspection on a 24-month rotating schedule. If abnormalities were seen, the patients were referred for additional care. The other women were assigned to usual care, which involved education about the disease but nothing else. The endpoint was survival from cervical cancer (the result of preinvasive disease).

Dr. Markman: In the usual-care group, no screening is done? They don't have resources to do it?

Dr. Coleman: That's right. With this very simple but very reproducible way of assessing women, the researchers were able to document a higher than 30% cancer mortality benefit. The screening test allowed them to see whether precancerous lesions existed.

Dr. Markman: As both the presenter and the discussant pointed out, this was beautiful science. They did it well and followed up well. The control group was adherent to the control and the treatment group was adherent to the treatment. They had an expert look at what these individuals in the community were trained to do. They did a good job, and the final slide showed that if this screening technique were used on a routine basis in India, more than 20,000 deaths would be prevented every year, and worldwide almost 80,000 deaths could be prevented with something as simple as this.

It was elegant science -- 12 years of follow-up -- and an enormous contribution. Everyone in the audience was extremely proud of what their colleagues had done for the women in their country.

Dr. Coleman: I would add that the findings are exportable. This could be done in almost any situation. One of the immediate benefits -- as well as a downstream effect -- is that the healthcare providers were trained. Young women were trained to do this assessment and have gained that knowledge. Now we have another generation of people who understand the importance of screening and the impact that it could have.


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