Next Generation Colposcopy- Can it Change the Landscape?

Abstract

Cervical cancer is preventable. That is what we know to be true. Cytology, vaccination and HPV DNA testing have enabled us to make remarkable progress in improving the sensitivity of screening programs. WHO states that 70% of women of the world should have undergone cervical testing by the year 2030¹. Nearly 90% of women dying from cervical cancer belong to low- or middle-income countries. In Pakistan, less than 1% of women get themselves screened annually². This astonishingly low number leaves much to be desired. Surely, whatever we are doing is not working like it should.

Our screening program can be fruitful if we keep a lower threshold to go to the next diagnostic step. The diagnosis of cervical cancer requires a colposcopy. In the past there were few indications to proceed to colposcopy, but in modern day practice it is justified in numerous situations. Whether a woman is HPV positive or pap negative with consistent vaginal discharge, she needs to be evaluated through the lens of a colposcope. In countries like Pakistan, there are numerous myths surrounding cervical cancer³. Many people believe it has a low incidence since women here are free from the usual risk factors of smoking or multiple sexual partners. That is why they believe it to be an ailment of the West. Moreover, Colposcopes are hardly available at tertiary centres and even if they are, they are kept under lock and key. So there has always been a huge deficiency of experts in this field. That is why we diagnose cervical cancer at an advanced stage- when it is already beyond the scope of surgery.