Cervical cancer claims more women's lives than any other cancer in India, but many women lack access to pap smears, the test which successfully curbed cervical cancer related-deaths in high-income countries. In 1998, Dr. Surendra S. Shastri embarked on a study to test the efficacy of using acetic acid — basically a sterilized vinegar — to detect cancerous cells in the cervix. He found that 31 percent of the women who were given this vinegar test were able to find the cancer before it was too late, according to Forbes

A routine pap smear involves a trained practitioner sampling cells from the lining of the cervix and sending them to a lab to be analyzed. India lacks the infrastructure to make these tests easily accessible, exemplified in the fact that cervical cancer kills 22,000 women a year in the country, compared to only 4,000 women in the U.S. In a low-tech alternative to pap smears, Dr. Shastri uses a technique involving acetic vinegar, which is swabbed onto the cervix. After just a minute, cervical lesions of cancer and precancerous cells turn white, while the normal healthy cells remain pink.

Since 1998, Dr. Shastri and a team of health workers used the vinegar test to screen half of the 150,000 women ages 35 to 64 participating in the study. At the beginning of the study the vinegar group's incidence of cervical cancer was close to that of the control group, with 26.7 per 100,000 women and 27.5 per 100,000 women, respectively. By the end of the study, deaths among the vinegar test group was significantly reduced to 11.1 versus 16.2 per 100,000 women, according to The Wall Street Journal. Women diagnosed with cervical cancer were offered free treatment to remove the lesions.

"This is great news for developing countries, that you can use simple, inexpensive technology and prevent thousands of deaths," Carol Aghajanian, chief of gynecological medical oncology at Memorial Sloan-Kettering Cancer Center, said. "It's inexpensive, it's simple, and it allows for immediate action."

The findings of the study will be presented at the annual meeting of the American Society of Clinical Oncology in Chicago. If this screening could be used throughout the developing world, it could save 73,000 lives each year.

Vinegar testing could save money in India, where a screening only costs a patient $1. In comparison, a pap smear and other tests for human papillomavirus (HPV), the virus that causes cervical cancer, costs $15 per screen.

Convincing women to get tested proved to be difficult in the conservative country. Women were either shy or scared, and often had to seek permission from their husbands or fathers to take the test, according to the Associated Press. Health workers travelled to slums to convince women to get screened.

"Many women refused to get screened," Usha Devi, one of the women who participated in the study said. "Some of them died of cancer later. Now I feel everyone should get tested. I got my life back because of these tests."

Other women would attend health talks out of curiosity, but when asked to participate in screenings, "they would totally refuse," said Vaishnavi Bhagat, one of the health workers.

"There was a sense of shame about taking their clothes off," Urmila Hadkar, another health worker, said. "A lot of them had their babies at home and had never been to a doctor. Sometimes just the idea of getting tested for cancer scared them. They would start crying even before being tested."

According to the U.S. Centers for Disease Control and Prevention (CDC), cervical cancer is one of the easiest female cancers to prevent, as long as screenings are done early. In the U.S., 12,000 women get cervical cancer a year, a number greatly reduced after the pap smear was introduced. However, worldwide, there are about 500,000 new cases and 250,000 deaths each year due to cervical cancer. Eighty percent of these are in low-income countries, according to the World Health Organization.

Although the study is the first to show that vinegar screening reduces deaths, the technique is used to spot cervical cancer on a small-scale in other countries. In the case that potentially cancerous lesions are found, a practitioner would remove the lesion immediately using cryotherapy, in which the affected area is burned off with extreme cold. There have also been pilots of this technique, known as VIA/cryo, conducted in more than 20 countries, including Ghana and Zimbabwe, according to The New York Times. It is also used in 29 of Thailand's 75 provinces, and 500,000 of the eight million women, ages 30 to 44 have been screened at least once.

New initiatives to prevent cervical cancer through HPV vaccinations will begin throughout Asia and Africa, in hopes of immunizing more than 30 million girls in more than 40 countries by 2020.