Experience with a novel community outreach approach to cervical cancer screening by colposcopy in the mobile unit

Background Screening is one of the three pillars of WHO’s 90-70-90 strategy to eliminate cervical cancer. Lack of awareness, access to screening services and infrastructure are the biggest obstacles to implementing screening in developing countries. We undertook a novel outreach initiative for screening by expert review of digital colposcopic images (digital image review (DIR)) captured by nurses. Methodology After defining the screening sites, eligible women between 30 and 65 years of age were counselled for screening by the local healthcare activist. Pre-test counselling and colposcopy were done by trained nurses. Digital images were captured and interpreted by the experts in the institute. Only women with abnormal or unsatisfactory images or benign abnormalities were called to the hospital for further evaluation. Results Out of 13 447 women, 707 women (5.3%) had abnormal DIR and 906 (6.7%) had unsatisfactory images. Out of the 1170 (72.5%) women who came for follow-up, 147 (12.6%) had lesions on colposcopy done by the experts. A Pap smear of these women revealed high-grade squamous intraepithelial lesions (SIL) in 31 women, low-grade SIL in 34 and atypical squamous cells of undetermined significance in 82 women. On colposcopy-directed biopsy, 15 had cervical intraepithelial neoplasia (CIN)2+, 5 had CIN-1 and 12 had no dysplasia. 12 women underwent hysterectomy at other centres. Conclusions A community outreach approach using colposcopy with the help of nurses ensures quality screening services at the doorstep of eligible women. It eliminates the need for doctors to go to the community. A robust plan for linkage to treatment is equally important.