In 2003, the famous Hong Kong singer Anita Mui died at a time when her career was on the rise, and the culprit that took away her young life and beautiful singing voice was cervical cancer. According to epidemiological statistics, among malignant tumors, cervical cancer is second only to breast cancer as a killer of women. There are about 500,000 new cases of cervical cancer worldwide each year, of which China accounts for 30%, and more than 30,000 women die each year as a result. Talking about this massacre figure, many people may think that once cervical cancer possesses you, it is only a matter of time before you have a “close encounter” with death. Indeed, most tumors are insidious in origin, and the human body has a powerful compensatory mechanism, so that normal physiological functions are almost unaffected at the beginning of lesion formation and even for a considerable period of time. In addition, many tumors are deeply hidden inside the body, which are often difficult to detect during routine physical examination, and at this time, if there is a lack of targeted examination measures, when the body feels abnormal. At this time, if there is a lack of targeted examination measures, by the time the body feels abnormal, it has often reached the point of no return. However, cervical cancer has its special features. First, from the physiological structure, the cervix can be seen with the naked eye with the help of tools. For example, during the examination, the doctor can open the vagina with the help of a speculum and easily expose the cervix to the view. This feature provides a unique advantage for cervical cancer screening. Secondly, most cases of cervical cancer can find a clear cause, and statistics show that more than 90% of cervical cancer is due to human papillomavirus (hereafter referred to as HPV) infection. In terms of genus, HPV is a DNA virus under the family of papillomaviridae, with human as the only host, and its favorite sites are skin and mucous membranes. Hundreds of genotypes of HPV viruses have been identified. These different subtypes of HPV can be classified into high-risk and low-risk types according to their pathogenicity. Studies have shown that 15 high-risk HPV types – particularly the two numbered 16 and 18 – cause cervical intraepithelial neoplasia and cervical cancer. For complex diseases such as cancer, it is not as simple as one might think to trace back to the source and establish a causal relationship between the cause and the disease, and requires a lot of practice and exploration. For example, early age of sexual debut and high number of sexual partners can lead to higher incidence of cervical cancer. It has been shown that the relative risk of cervical cancer is more than three times higher for those with more than 10 sexual partners than for those with one partner. The risk of cervical cancer increases by 5 to 10 times if the number of sexual partners is 6 or more and the first sexual intercourse is before the age of 15. This phenomenon suggests that cervical cancer may have the properties of a sexually transmitted disease, and if the vector of transmission can be interrupted, the cause of cervical cancer may be identified. The burden fell on German virologist Chur Hausen. He first proposed the hypothesis that HPV infection was closely related to cervical cancer in 1976, when it was widely believed that the herpes simplex virus type 2 virus caused cervical cancer. Later, Hausen carried out extensive validation work and cloned HPV16 and HPV18 in succession, and more convincingly, HPV16 was detected in more than half of the tumor specimens from cervical cancer patients and HPV18 in 20% of the specimens. A large epidemiological survey conducted in 1991 finally showed conclusively that HPV is indeed the causative agent of cervical cancer. It was for this contribution that Hausen shared the 2008 Nobel Prize in Physiology or Medicine with the two scientists who discovered HIV, and also won high praise for “his courageous work in rejecting dogma, which has led to an understanding of the relationship between HPV and cervical cancer and has contributed to the development of a vaccine against HPV. He is highly praised for his work. Acetic acid: a screening tool With the cause of cervical cancer known, the first goal is to stop and prevent cervical cancer. As mentioned above, the special physiology of the human cervix creates an inherent advantage for the detection and screening of cervical cancer. As early as the 1820s, the Greek medical scientist Papanicolaou began to use this advantage to screen for cervical cancer and invented the great “Pap smear” method. This method, in short, involves the use of a sterile cork blade to scrape gently across the cervix and microscopic examination to see if abnormal tumor cells are present in the scraped cells. In 1951, under the initiative of Professor Qiaozhi Lin, a renowned obstetrician and gynecologist, Professor Da-Wang Yang introduced the Pap smear method to China and launched a large-scale cervical cancer screening campaign in the 1970s. The effect of this initiative was immediate, and the early detection of early cervical cancer and precancerous lesions led to a downward trend in the incidence and mortality rate of cervical cancer in China. Compared to other countries, the mortality of cervical cancer in China has improved significantly, dropping from a high level in the 1970s to a moderate level. However, with a large population, a thin base and uneven regional development, even a relatively simple and easy-to-use method such as Pap smear is not universally available to all women. The cervical epithelial cells obtained by this method need to be manually identified as abnormal or not, which requires a high level of experience of the doctor reading the film. Although computer-assisted cervical cytology systems have been developed in recent years with high accuracy rates, they are limited to central cities and are difficult to reach wider areas where medical resources are lacking. It has been the goal of researchers in this field to find an inexpensive, easy-to-use, easy-to-identify, and suitable method for cervical cancer screening in less developed areas. The so-called vinegar white test refers to the application of a cotton ball soaked with 3%-5% acetic acid to the cervix and the visual observation of changes in the cervical epithelium. As the normal cervical epithelium is rich in glycogen, the transparency is better and the white color will subside after a period of time, while the abnormal cervical epithelium is denser and has a lower glycogen content, the epithelial protein coagulates and denatures after applying acetic acid thus turning white, hence the name vinegar white epithelium. Doctors have observed that patients with this condition are quite likely to develop cervical cancer or precancerous lesions. However, medicine is an evidence-based discipline. A diagnosis that is not “tested” by evidence-based medicine can be misdiagnosed or missed, with the former resulting in a waste of medical resources and the latter meaning an increased risk of death. Dr. Shastri’s clinical study is designed to address this issue. Dr. Shastri led his research team to the poorest regions of India, where infrastructure is poor, medical resources are scarce, and Pap smears are not feasible. A total of 150,000 women were included in the study over a period of eight years. The results showed that women who were screened had a dramatic one-third reduction in the risk of death from cervical cancer compared to the control group. If applied to all of India, 22,000 deaths would be avoided, a figure that could rise to 72,000 once it is universally applied in low- and middle-income countries around the world. Another highlight of the study is that most of the health care workers who provide screening services have only a junior high school degree and can complete the full training in just six months, which significantly lowers the threshold for screening. Dr. Electra D. Paskett of the Ohio State University Comprehensive Cancer Center in Columbus said, “This study demonstrates that the vinegar-white test is a “perfect alternative” to Pap smears in a resource-poor setting, and that even in developed countries, there is room for the vinegar-white test to work. There is room for it to work, even in developed countries.” It is clear that the Indian experience is of great relevance to China’s vast central and western regions, which lack medical resources. Vaccine: the end of cervical cancer Early diagnosis and prevention is the universal rule for almost all tumors at this stage, especially for cervical cancer, which has a clear cause. If the vaccine can be used to catch HPV before it “sneaks into the village”, we can not only save the need to “shoot”, but also eventually achieve the complete elimination of HPV. It is not a luxury to talk about the complete eradication of cervical cancer caused by HPV. In fact, Professor Hausen began lobbying pharmaceutical companies to initiate the development of an HPV vaccine as soon as the virus was discovered in cervical cancer tumor tissue in 1984. Today, the effectiveness and safety of the HPV vaccine has been validated by the U.S. Food and Drug Administration, the U.S. Centers for Disease Control and Prevention and the World Health Organization. Cervical cancer vaccines are approved for use in more than 160 countries worldwide, including 28 countries that have free vaccination policies for students and adolescents. The HPV vaccine is also widely available in Hong Kong, Macau, Taiwan and Singapore, where the Chinese community predominates. Unfortunately, so far, imported HPV vaccines are still in a lengthy approval process in China, and domestic HPV vaccines have not yet been developed successfully. In other words, Chinese women facing HPV fashion cannot be protected by the vaccine, and an important link is missing in the cervical cancer defense line, which means the power of the giant cervical cancer catcher is greatly weakened.