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Deaths from cervical cancer in the U.S. and other developed countries declined dramatically over the latter half of the 20th century. That's partly because pap smears have become a routine part of women's health checkups. But in the developing world they're not routine and women continue to die from the highly treatable form of cancer. According to the World Health Organization, roughly 80 percent of cervical cancer deaths now occur in low income countries. NPR's Jason Beaubien reports now on a growing push for the low-tech alternative to pap smears, one that uses little more than household vinegar.

JASON BEAUBIEN, BYLINE: In Botswana at a small clinic behind the Princess Marina Hospital in the capital, Dr. Doreen Ramogola-Masire is in a rush. Matronly women in their 30s and 40s are sitting on long benches in the clinic's central corridor waiting to be screened for cervical cancer. Ramogola-Masire clicks through photos on a Motorola cell phone.

DR. DOREEN RAMOGOLA-MASIRE: This is normal cervix. It's nice pink.

BEAUBIEN: But then on the later image on the phone there's a cloudy white area on a cervix.

RAMOGOLA-MASIRE: And that is abnormality we're talking about. So this is quite thick. So to me that will be a moderate, severe abnormality.

BEAUBIEN: That abnormality is tissue that may eventually turn into cervical cancer and if it does, Ramogola-Masire says, it will probably be fatal. Across Africa, most women are never screened for cervical cancer. Pap smears require tissue samples to be analyzed in a lab. The results then have to get shipped back to clinics where they may or may not ever reach the original patient. Even testing for HPV which causes most cases of cervical cancer is difficult in places where women only sporadically access health care. Ramogola-Masire in Botswana is using a much simpler approach.

RAMOGOLA-MASIRE: One visit. Same visit.

BEAUBIEN: Ramogola-Masire simply swabs a woman's cervix with vinegar and then looks to see if any potentially cancerous abnormalities have turned white. If pre-cancerous lesions are present, she freezes them off with nitrous oxide.

RAMOGOLA-MASIRE: She's lying on the couch, you look at it, you wash it with vinegar. You take a picture. You can immediately review the picture because you've got a screen, so you can say to them, this is the white change and I think this is where the abnormality is. We are going to freeze it and what happens, the freezing actually takes care of the top layer, it just sluffs(ph) that off. And hopefully, you've taken care of the problem.

BEAUBIEN: The picture can even be taken with a cell phone and sent to a doctor for review. Although on this day, Ramogola-Masire is using a digital camera. The entire process can be done by a trained mid-wife and take only a few minutes. If the patient already has developed cancer, this vinegar test will show that, but the treatment is far more complex. At least six countries in Africa have started using the vinegar screening technique in government health clinics. It's also caught on in Thailand and several other Asian countries. Ricky Lu with the global health group, Jhpiego from Johns Hopkins University, has been studying the technique as alternative to pap smears for more than a decade.

DR. RICKY LU: We have already seen that the pap smear hasn't worked as a public health intervention for preventing cervical cancer in low and middle income countries.

BEAUBIEN: Dr. Lu has a slightly different procedure from Dr. Ramogola-Masire in Botswana. Rather than using nitrous oxide to freeze any abnormal lesions, Jhpeigo is using carbon dioxide or dry ice. This, Dr. Lu says, is because carbon dioxide is more widely available.

LU: Dry ice or carbon dioxide is always going to be available where you would probably find Coca-Cola or Pepsi bottling companies because they run their soda companies using carbon dioxide as well. So there must be some source of carbon dioxide somewhere.

BEAUBIEN: The dry ice or the nitrous oxide is delivered to the tip of the cervix with a wand that costs about $2,000. This is the most expensive part of the procedure. Jhpiego is trying to come up with a cheaper alternative.

MARTIN VARADY: Basically, all you have to do is turn it on for about 10 seconds.

BEAUBIEN: Martin Varady with Jhpiego just got his masters in bio-medical engineering from Johns Hopkins. He's holding a prototype of a dry ice delivery system that uses a compact 5-pound CO2 gas canister.

VARADY: Currently with the existing devices they usually get about 10 to 15 patients on a big 50-pound tank, but with this one, this is just the small 5-pound tank, we expect that we should be able to treat about 25 to 30 women.

BEAUBIEN: This new system, which they're still refining, could cost just a couple of hundred dollars, fit in a backpack and allow potentially life-saving cervical cancer screening in even the most remote parts of the world. Jason Beaubien, NPR News.

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