January was Cervical Health Awareness Month, and this year, that designation held special significance for Nimmi Ramanujam, professor of biomedical engineering and global health and director of the Center for Global Women’s Health Technologies.
Since 2012, she and her research team have been developing and testing a portable colposcope, called the “Pocket Colposcope,” to increase access to cervical cancer screening in primary care settings. Last month, 20 of these devices were produced for distribution to international partners.
According to the World Health Organization (WHO), more than 85 percent of the more than 270,000 annual deaths from cervical cancer occur in low and middle income countries. The disease is easily treatable if identified early, but because access to effective screening is limited in low-resource settings, early detection is often not possible.
The discovery, which is a device that is pocket-sized, comes less than two years after she was awarded a National Institutes of Health R01 grant to work with industry and nonprofit partners to develop strategies for wide-scale screening for cervical cancer in East Africa.
This point-of-care tampon colposcope provides a solution to the many challenges of screening in low and middle-income countries, according to a Duke Chronicle report. “While cervical cancer mortality is on the decline in the United States and developed countries, it’s actually on the rise in lower resource settings,” Marlee Kreiger, research program manager in the Ramanujam lab, said in the report. “What we’ve done to address this disparity is we’ve created the ‘pocket’ colposcope, which as the name suggests, means the device can fit in the pocket of a physician or a healthcare worker, enabling them to take the device anywhere to screen a woman.”
The report notes that in low- and middle-income countries, the progress of public education and the use of the Pap smear has not met those of developed countries, citing a World Health Organization estimate that upwards of 88 percent of cervical cancer-related deaths happen in underdeveloped countries.
Now, with the colposcope produced by Ramanujam, a Robert W. Carr Jr. professor of biomedical engineering, and her team from the Pratt School of Engineering, anyone could get the device for no more than a few hundred dollars, the report said. Typical colposcopes can cost anywhere from $5,000 to $20,000.
What’s more, the device doesn’t involve much training compared to its pricier counterparts. Capturing the necessary images, according to the Chronicle report citing Krieger, can be executed by midwives, nurses or even the patients. Additionally, the camera can be attached to any USB-capable device, opening the door to save and send images to healthcare professionals, it said.
In the Ramanujam lab’s design, the inserter acts as a replacement for the traditional speculum, a device which is designed to spread the vaginal walls and make the cervix visible for examination, the report said, adding it may lead to more women being open to trying it as it likely will result in less discomfort.
“Through the inserter, we hope that cervical cancer screening will be more comfortable and thus more women would be encouraged to get screened,” Júlia Sroda Agudogo, who helped to develop the device as an undergraduate, said in the Chronicle report. “Additionally, the promise of the inserter to be used for self-colposcopy would be critical in more conservative settings in which women are deterred from screening due to the stigma associated with screening by a male physician.”
In a pilot clinical study conducted by the Duke group, 100 percent of participants deemed the inserter used with the “pocket” colposcope to be more comfortable than the traditional speculum, the report said.
Noted Dr. John Schmitt, director of Duke’s Cervical Cancer Prevention Clinic and professor of obstetrics and gynecology, in the report, “The future holds some really good screening technique where you can identify cancer precursors that are very easy to treat and don’t affect fertility and don’t affect mortality. The vision right now is that you can eventually screen women very easily.”
The hope is to introduce the device across countries such as India and others, including Peru, Tanzania and Zambia, the report said. “The response has been amazing,” Schmitt said in the report of the pilot study. “I’ve had several people just say, ‘well, can we just stop using what we’re using’—which typically is either a cell phone or a handled 35 mm camera to record images—’and use this’?”