How AI and digital tools can aid in cervical cancer screening and diagnosis

Back in 2015 and 2016, as I was wrapping up my Master’s program at the University of Oxford (UK), my focus was on a matter of global significance – cervical cancer elimination. My dissertation had a singular focus: understanding the policies and strategies of three different countries: Botswana, Rwanda and South Africa. My goal? To understand the barriers and solutions in putting cervical cancer policies into action.

Fast forward to 2020: we witnessed a groundbreaking moment in global health. In November 2020, the World Health Organization (WHO) unveiled a strategy – a global commitment to eliminate cervical cancer. Cervical cancer is one cancer we can eliminate. It is one of the most common cancers globally – every woman and person with a cervix is at risk. Unlike many other cancers, the known cause of cervical cancer is a persistent infection of high-risk human papillomavirus (hrHPV). The crucial thing about cervical cancer is that it is largely preventable and manageable, especially when detected early and treated effectively.

We have the chance to eliminate one cancer because the tools to eliminate cervical cancer are already available – from primary prevention, such as timely HPV vaccination, secondary prevention through regular screening with high performance tests such as HPV-DNA tests, and if needed, prompt treatment. The WHO has classified these strategies as ‘best-buy interventions’ with immediate returns on investment – to illustrate, it is estimated that the economy will see a return of approximately US$3.20 for every dollar invested through 2050 due to increased participation of women in the workforce.

In 2020, over 600,000 women were diagnosed with cervical cancer globally, and 340,000 died from the disease, resulting in 210,000 new maternal orphans. So, why do we still grapple with cervical cancer-related deaths? The answer lies in inequalities stemming from geography, socio-economic status, cultural barriers, social stigma, structural and healthcare systems and funding. These disparities disproportionately affect women in low- and middle-income countries. However, here is the thing: even in high-income countries with significant progress; vulnerable populations still face a higher risk of cervical cancer.

In our era of innovation, digital and AI technologies, there is a remarkable potential to accelerate cervical cancer elimination with these innovations. During the coronavirus (COVID-19) pandemic, we witnessed a surge in the use of technology for things like health education, surveillance, testing, results and overall healthcare delivery. It was a glimpse into what is possible when we harness the power of technology to tackle public health challenges.

So how can we use this technology in our quest to eliminate cervical cancer?

1. Digital platforms to deliver real-time reporting and seamless service. Eliminating cervical cancer poses numerous obstacles. Consider the hurdles of cervical cancer screening: lack of awareness about its benefits, social stigma, misconceptions, structural issues like limited access to healthcare services, and shortage of trained healthcare workers. In high-burden countries, low HPV vaccination rates compound the problem, making increased screening participation crucial. The groundbreaking method of self-collection for cervical cancer screening not only helps to address some of the hurdles but also offers flexibility, meeting women where they are. Take, for example, Program R.O.S.E (Removing Obstacles to Cervical Screening), a multi-stakeholder initiative in Malaysia. Program R.O.S.E uses self-collection to improve screening rates, especially among hard-to-reach underserved and under-screened populations, with a combination of mobile-based digital health platforms to deliver real-time reporting to women and facilitate seamless follow-ups and linkage to care for treatment if required.

2. Digital technology to enable remote care and address health workforce shortage. The WHO estimates that by 2030, there will be a shortage of 10 million healthcare workers, and the hardest hit areas will be lower-middle-income countries, which are the very same places struggling to eliminate cervical cancer. Even in countries that have made considerable progress to eliminate cervical cancer, access to care is not equal for all. Take, for example, Texas in the United States using technology to address high cervical cancer rates in Medically Underserved Areas (MUAs). Project ECHO is an example of such a digital healthcare innovation, an initiative started in 2014 dedicated to cervical cancer prevention started at MD Anderson (TX, USA) with partnerships with other institutions across Texas. Project ECHO focuses on MUAs through tele-mentoring, connecting with healthcare providers to discuss clinical guidelines and best practices for cervical cancer prevention. Programs like Project ECHO overcome the challenges of reaching rural, remote and underserved areas; they use technology to bridge the gap in healthcare accessibility and quality.

3. Data-driven insights to improve care delivery and outcomes. Tracking progress and gathering evidence are crucial steps to achieving the WHO 90-70-90 targets for cervical cancer. Screening and survival rates are vital indicators, and data helps understand how effective cervical cancer screening programs are. Digital tools for care management like Roche’s navify® Cervical Screening software can collect and analyze population-based data on screening rates and guideline adherence and inform us on opportunities and gaps for improvement. For instance, The WHO aims for 70% of women to be screened for HPV twice in their lifetime between ages 35 and 45 with a high-performance test, with a ten-year gap in other countries at 3–5 year intervals. Many countries are seeing a drop in follow-up screening (after an abnormal test and also within the specified interval for women with a negative test result to return), and the shocking reality is that globally, only 36% of women have been screened for cervical cancer at least once in their lifetime – 84% in high-income countries and less than 20% in low-and-middle-income countries. As countries repurpose the investments made during the COVID-19 pandemic, they can use surveillance systems to monitor cervical cancer screening programs and other digital systems to improve health system capacity and deliver more efficient preventive services.

4. Social media and other digital platforms to empower women, patients, and survivors to increase awareness and advocacy efforts to accelerate elimination. Social media platforms have proven to be dynamic in helping to raise awareness and mobilize communities to share knowledge. Data reveals that women are 75–85% more likely to use digital tools for their healthcare needs, demonstrating that women are embracing digital technology for their healthcare needs and making it a powerful way to drive messages and engage in cervical cancer elimination. Women are not just passive users; they share knowledge, create content and stay informed about various health conditions. This presents an opportunity for using the platform for awareness in raising and dismantling stigma, and promoting preventive measures. Organizations like Cervivor (USA) and Teal Sisters Foundation Zambia (Lusaka, Zambia) are stellar examples of organizations using social media and digital platforms to unite survivors and educate women on cervical cancer. They harness the power of social media and other digital platforms to bring cervical cancer survivors together, spread awareness, educate and provide support. Numerous online platforms and communities exist, such as Medicaid Cancer Foundation and the Global Initiative Against HPV and Cervical Cancer, reaching a vast audience. These platforms foster empowerment and solidarity to make cervical health a priority.

In the global effort to eliminate cervical cancer, the WHO’s call to action has enabled equity in access to preventive measures and treatment at the forefront of elimination. The impact of the 90-70-90 target is staggering, with the potential to avert hundreds of thousands of deaths by 2030 (300,000–400,000), millions by 2070 (14.6million), and 62.6 million over the century. Behind these statistics are real lives – daughters, mothers, sisters, friends. We can eliminate cervical cancer with unwavering dedication, political commitment, and sustainable funding. Digital solutions to support cervical cancer elimination are a vital part of the puzzle – a tool to reshape how we approach understanding, preventing, treating and managing this disease. However, we must acknowledge that not everyone has equal access to these innovative digital technologies or platforms. So, when we talk about using technology to accelerate cervical cancer elimination, this is not a silver bullet solution but rather a vital part of the puzzle, a tool to reshape how we approach understanding, preventing, treating, and managing this disease within a population segment.