Advancing Cervical Cancer Care: A Comprehensive Study of Screening Approach for Tribal Women in Sub-Saharan Africa and Asia
-
Jennyfer Susan Maliakkal Babu
,
Parthasarathy Subashini
,
Thookanayakanpalayam Thyagarajan Dhivyaprabha
Abstract
Background: Cervical cancer is one of the leading causes of cancer-related mortality among women in developing regions, particularly within tribal populations of Sub-Saharan Africa and Asia. This study aimed to evaluate existing screening strategies in tribal communities, compare them with global best practices, and explore the feasibility of smart colposcopy as an effective screening tool in low-resource settings.
Methods: A mixed-methods approach was employed, combining systematic literature review 2000-2024, case study analysis, and technical evaluation. Data were collected from peer-reviewed journals, healthcare databases, and open-access medical image repositories. The diagnostic utility and usability of smart colposcopy using the Eva System were assessed. Advanced image processing techniques, including CNN-based detection and partial convolution inpainting, were applied to improve visual clarity by mitigating artifacts like specular reflection.
Results: Findings reveal significant screening barriers in tribal regions, such as fear, stigma, and infrastructural deficits. Compared to structured programs in developed countries, tribal areas show lower compliance. Smart colposcopy demonstrated high potential for remote screening due to its portability and real-time AI support. Image quality enhancements improved diagnostic accuracy.
Conclusion: Smart colposcopy, integrated with awareness initiatives and supportive policies, offers a scalable solution to improve early detection and reduce cervical cancer mortality in tribal and underserved populations.
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4. Brito EB, Martins SJ, Menezes RC (2002). Human papillomaviruses in Amerindian women from Brazilian Amazonia. Epidemiol Infect, 128 (3): 485-489.
5. Yang M, Du J, Lu H, Xiang F, Mei H, Xiao H (2022). Global trends and age-specific incidence and mortality of cervical cancer from 1990 to 2019: an international comparative study based on the Global Burden of Disease. BMJ Open, 12 (7): e055470.
6. Singh M, Jha RP, Shri N, et al (2022). Secular trends in incidence and mortality of cervical cancer in India and its states, 1990-2019: data from the Global Burden of Disease 2019 Study. BMC Cancer, 22 (1): 149.
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8. George JT (2021). Factors influencing utilization of cervical cancer screening services among women - a cross sectional survey. Clin Epidemiol Glob Health, 11: 100752.
9. Ezechi OC, Gab-Okafor CV, Ostergren PO, et al (2013). Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. BMC Public Health, 13: 46.
10. Lidofsky A, Miller A, Jorgensen J, et al (2019). Development and implementation of a culturally appropriate education program to increase cervical cancer screening among Maasai women in rural Tanzania. Ann Glob Health, 85 (1): 127.
11. Lee NC, Wong FL, Jamison PM, et al (2014). Implementation of the national breast and cervical cancer early detection program: the beginning. Cancer, 120 Suppl 16(0 16):2540-8.
12. Susan MJ, Subashini P (2023). Improvising grading of cervical cancer using quality assessment method in smart colposcopy images. Measurement: Sensors, 27: 100788.
13. Wang X, Li P, Lv Y, et al (2021). Integration of global and local features for specular reflection inpainting in colposcopic images. J Healthc Eng, 2021: 5401308.
14. Xue Z, Novetsky AP, Einstein MH, et al (2020). A demonstration of automated visual evaluation of cervical images taken with a smartphone camera. Int J Cancer, 147 (9): 2416-2423.
15. Susan J, Subashini P (2019). Design and development of webportal for cervical cancer diagnosis using MobileODT images. In: 2019 IEEE International Smart Cities Conference (ISC2). IEEE, pp: 118-121.
16. MobileODT (2021). Enhanced Visual Assessment System EVA System - Software Guide. Available from: https://portal.mobileodt.com/Help/EVA-Hardware-Guide (Accessed October 17, 2021).
17. MobileODT (2021). Statistics on Clinical Activities and Practices of Cervical Cancer Clinics in Kenya. Available from: https://www.mobileodt.com/medical-research/clinical-activities-cervical-cancer-screening-camps-stationary-clinics-kenya/ (Accessed October 17, 2021).
18. El Meslouhi O, Kardouchi M, Allali H, et al (2011). Automatic detection and inpainting of specular reflections for colposcopic images. Cent Eur J Comput Sci, 1: 341-354.
19. Peterson CW, Rose D, Mink J, Levitz D (2016). Real-time monitoring and evaluation of a visual-based cervical cancer screening program using a decision support job aid. Diagnostics (Basel), 6 (2): 20.
20. Susan MJ, Subashini P, Krishnaveni M, et al (2023). Detection of specular reflection from smart colposcopy image using RGB color space and convolutional neural network. Int J Eng Trends Technol, 71 (10): 29-38.
21. Susan MJ, Subashini P, Krishnaveni M (2022). Comparison of various deep learning inpainting methods in smart colposcopy images. Int J Comput Intell Stud, 11 (1): 53-72.
22. Parvez R, Hedau S, Bhattacharya D, et al (2012). High-risk HPV infection among the tribal and non-tribal women of the Andaman and Nicobar Islands, India. Public Health, 126 (1): 67-69.
23. Ghosh S, Pattanshetty SM, Mallya SD, et al (2021). Cervical cytology and associated factors among tribal women of Karnataka, India. PLoS One, 16 (3): e0248963.
24. Ghosh S, Mallya SD, Shetty RS, et al (2021). Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population: a community-based study from southern India. J Racial Ethn Health Disparities, 8: 88-93.
25. Patil AD, Salvi NR, Shahina B, et al (2019). Perspectives of primary healthcare providers on implementing cancer screening services in tribal block of Maharashtra, India. South Asian J Cancer, 8 (3): 145-149.
26. Parmar CP, Saiyed SL, Vora KS (2020). Health system preparedness for screening of cervical cancer: situational analysis in tribal district of Gujarat State, India. Community Med, 11 (2): 57-63.
27. Intahphuak S, Nambunmee K, Kuipiaphum P (2021). Factors influence on PAP test screening among Lahu hill tribe women in remote area Thailand. Asian Pac J Cancer Prev, 22 (7): 2243-49.
28. Kritpetcharat O, Wutichouy W, Sirijaichingkul S, et al (2012). Comparison of Pap smear screening results between Akha hill tribe and urban women in Chiang Rai province, Thailand. Asian Pac J Cancer Prev, 13 (11): 5501-5504.
29. Wongwatcharanukul L, Promthet S, Bradshaw P, et al (2014). Factors affecting cervical cancer screening uptake by Hmong hilltribe women in Thailand. Asian Pac J Cancer Prev, 15 (8): 3753-3756.
30. Mutambara J, Mutandwa P, Mahapa M, et al (2017). Knowledge, attitudes and practices of cervical cancer screening among women who attend traditional churches in Zimbabwe. J Cancer Res Pract, 4 (2): 53-58.
31. Kaneko N (2018). Factors associated with cervical cancer screening among young unmarried Japanese women: results from an internet-based survey. BMC Womens Health, 18: 132.
32. Jradi H, Bawazir A (2019). Knowledge, attitudes, and practices among Saudi women regarding cervical cancer, human papillomavirus (HPV) and corresponding vaccine. Vaccine, 37 (3): 530-537.
33. Waller J, Bartoszek M, Marlow L, et al (2009). Barriers to cervical cancer screening attendance in England: a population-based survey. J Med Screen, 16 (4): 199-204.
34. Elfström KM, Arnheim-Dahlström L, von Karsa L, et al(2015). Cervical cancer screening in Europe: quality assurance and organisation of programmes. Eur J Cancer, 51 (8): 950-968.
35. Anttila A, Nieminen P (2007). Cervical cancer screening programme in Finland with an example on implementing alternative screening methods. Coll Antropol, 31 Suppl 2:17-22.
36. Canfell K, Sitas F, Beral V (2006). Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust, 185 (9): 482-486.
37. Creighton P, Lew JB, Clements M, et al (2010). Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years. BMC Public Health, 10: 734.
38. Elazab M, Ali O, Ramadan MC, et al (2021). The prevalence of human papilloma virus (HPV) among Egyptian women and its impact: an observational study. Open J Obstet Gynecol, 11 (7): 879-884.
39. Boselli F, De Martis S, Rivasi F, et al (2000). The Italian experience of a Pap test and speculoscopy based screening programme. J Med Screen, 7 (3): 160-162.
40. PR Newswire (2021). Israeli FemTech Company MobileODT, Engaged in Large Scale Government Cervical Cancer Screening Project. Available from: https://www.prnewswire.com/news-releases/israeli-femtech-company-mobileodt-engaged-in-large-scale-government-cervical-cancer-screening-project-301256186.html (Accessed October 17, 2021).
41. MobileODT (2021). Cervical Cancer Screening in China: MobileODT Takes Part in the Largest Ever Self-Swab HPV Study. Available from: https://www.mobileodt.com/blog/cervical-cancer-screening-in-china-largest-ever-self-swab-hpv-study/
2. Mayo Clinic (2021). Cervical Cancer. Available from: https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501 (Accessed October 17, 2021).
3. Rahman M, Mia AR, Haque SE, et al (2013). Beating cervical cancer in the developed countries: a dream or a reality? In: Current Topics in Public Health. IntechOpen, pp: 299-320.
4. Brito EB, Martins SJ, Menezes RC (2002). Human papillomaviruses in Amerindian women from Brazilian Amazonia. Epidemiol Infect, 128 (3): 485-489.
5. Yang M, Du J, Lu H, Xiang F, Mei H, Xiao H (2022). Global trends and age-specific incidence and mortality of cervical cancer from 1990 to 2019: an international comparative study based on the Global Burden of Disease. BMJ Open, 12 (7): e055470.
6. Singh M, Jha RP, Shri N, et al (2022). Secular trends in incidence and mortality of cervical cancer in India and its states, 1990-2019: data from the Global Burden of Disease 2019 Study. BMC Cancer, 22 (1): 149.
7. Singh D, Vignat J, Lorenzoni V, et al (2023). Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health, 11 (2): e197-e206.
8. George JT (2021). Factors influencing utilization of cervical cancer screening services among women - a cross sectional survey. Clin Epidemiol Glob Health, 11: 100752.
9. Ezechi OC, Gab-Okafor CV, Ostergren PO, et al (2013). Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. BMC Public Health, 13: 46.
10. Lidofsky A, Miller A, Jorgensen J, et al (2019). Development and implementation of a culturally appropriate education program to increase cervical cancer screening among Maasai women in rural Tanzania. Ann Glob Health, 85 (1): 127.
11. Lee NC, Wong FL, Jamison PM, et al (2014). Implementation of the national breast and cervical cancer early detection program: the beginning. Cancer, 120 Suppl 16(0 16):2540-8.
12. Susan MJ, Subashini P (2023). Improvising grading of cervical cancer using quality assessment method in smart colposcopy images. Measurement: Sensors, 27: 100788.
13. Wang X, Li P, Lv Y, et al (2021). Integration of global and local features for specular reflection inpainting in colposcopic images. J Healthc Eng, 2021: 5401308.
14. Xue Z, Novetsky AP, Einstein MH, et al (2020). A demonstration of automated visual evaluation of cervical images taken with a smartphone camera. Int J Cancer, 147 (9): 2416-2423.
15. Susan J, Subashini P (2019). Design and development of webportal for cervical cancer diagnosis using MobileODT images. In: 2019 IEEE International Smart Cities Conference (ISC2). IEEE, pp: 118-121.
16. MobileODT (2021). Enhanced Visual Assessment System EVA System - Software Guide. Available from: https://portal.mobileodt.com/Help/EVA-Hardware-Guide (Accessed October 17, 2021).
17. MobileODT (2021). Statistics on Clinical Activities and Practices of Cervical Cancer Clinics in Kenya. Available from: https://www.mobileodt.com/medical-research/clinical-activities-cervical-cancer-screening-camps-stationary-clinics-kenya/ (Accessed October 17, 2021).
18. El Meslouhi O, Kardouchi M, Allali H, et al (2011). Automatic detection and inpainting of specular reflections for colposcopic images. Cent Eur J Comput Sci, 1: 341-354.
19. Peterson CW, Rose D, Mink J, Levitz D (2016). Real-time monitoring and evaluation of a visual-based cervical cancer screening program using a decision support job aid. Diagnostics (Basel), 6 (2): 20.
20. Susan MJ, Subashini P, Krishnaveni M, et al (2023). Detection of specular reflection from smart colposcopy image using RGB color space and convolutional neural network. Int J Eng Trends Technol, 71 (10): 29-38.
21. Susan MJ, Subashini P, Krishnaveni M (2022). Comparison of various deep learning inpainting methods in smart colposcopy images. Int J Comput Intell Stud, 11 (1): 53-72.
22. Parvez R, Hedau S, Bhattacharya D, et al (2012). High-risk HPV infection among the tribal and non-tribal women of the Andaman and Nicobar Islands, India. Public Health, 126 (1): 67-69.
23. Ghosh S, Pattanshetty SM, Mallya SD, et al (2021). Cervical cytology and associated factors among tribal women of Karnataka, India. PLoS One, 16 (3): e0248963.
24. Ghosh S, Mallya SD, Shetty RS, et al (2021). Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population: a community-based study from southern India. J Racial Ethn Health Disparities, 8: 88-93.
25. Patil AD, Salvi NR, Shahina B, et al (2019). Perspectives of primary healthcare providers on implementing cancer screening services in tribal block of Maharashtra, India. South Asian J Cancer, 8 (3): 145-149.
26. Parmar CP, Saiyed SL, Vora KS (2020). Health system preparedness for screening of cervical cancer: situational analysis in tribal district of Gujarat State, India. Community Med, 11 (2): 57-63.
27. Intahphuak S, Nambunmee K, Kuipiaphum P (2021). Factors influence on PAP test screening among Lahu hill tribe women in remote area Thailand. Asian Pac J Cancer Prev, 22 (7): 2243-49.
28. Kritpetcharat O, Wutichouy W, Sirijaichingkul S, et al (2012). Comparison of Pap smear screening results between Akha hill tribe and urban women in Chiang Rai province, Thailand. Asian Pac J Cancer Prev, 13 (11): 5501-5504.
29. Wongwatcharanukul L, Promthet S, Bradshaw P, et al (2014). Factors affecting cervical cancer screening uptake by Hmong hilltribe women in Thailand. Asian Pac J Cancer Prev, 15 (8): 3753-3756.
30. Mutambara J, Mutandwa P, Mahapa M, et al (2017). Knowledge, attitudes and practices of cervical cancer screening among women who attend traditional churches in Zimbabwe. J Cancer Res Pract, 4 (2): 53-58.
31. Kaneko N (2018). Factors associated with cervical cancer screening among young unmarried Japanese women: results from an internet-based survey. BMC Womens Health, 18: 132.
32. Jradi H, Bawazir A (2019). Knowledge, attitudes, and practices among Saudi women regarding cervical cancer, human papillomavirus (HPV) and corresponding vaccine. Vaccine, 37 (3): 530-537.
33. Waller J, Bartoszek M, Marlow L, et al (2009). Barriers to cervical cancer screening attendance in England: a population-based survey. J Med Screen, 16 (4): 199-204.
34. Elfström KM, Arnheim-Dahlström L, von Karsa L, et al(2015). Cervical cancer screening in Europe: quality assurance and organisation of programmes. Eur J Cancer, 51 (8): 950-968.
35. Anttila A, Nieminen P (2007). Cervical cancer screening programme in Finland with an example on implementing alternative screening methods. Coll Antropol, 31 Suppl 2:17-22.
36. Canfell K, Sitas F, Beral V (2006). Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust, 185 (9): 482-486.
37. Creighton P, Lew JB, Clements M, et al (2010). Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years. BMC Public Health, 10: 734.
38. Elazab M, Ali O, Ramadan MC, et al (2021). The prevalence of human papilloma virus (HPV) among Egyptian women and its impact: an observational study. Open J Obstet Gynecol, 11 (7): 879-884.
39. Boselli F, De Martis S, Rivasi F, et al (2000). The Italian experience of a Pap test and speculoscopy based screening programme. J Med Screen, 7 (3): 160-162.
40. PR Newswire (2021). Israeli FemTech Company MobileODT, Engaged in Large Scale Government Cervical Cancer Screening Project. Available from: https://www.prnewswire.com/news-releases/israeli-femtech-company-mobileodt-engaged-in-large-scale-government-cervical-cancer-screening-project-301256186.html (Accessed October 17, 2021).
41. MobileODT (2021). Cervical Cancer Screening in China: MobileODT Takes Part in the Largest Ever Self-Swab HPV Study. Available from: https://www.mobileodt.com/blog/cervical-cancer-screening-in-china-largest-ever-self-swab-hpv-study/
| Files | ||
| Issue | Vol 54 No 10 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i10.20134 | |
| Keywords | ||
| Cervical cancer screening Tribal populations Smart colposcopy Image processing Healthcare disparities | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Babu JSM, Subashini P, Dhivyaprabha TT. Advancing Cervical Cancer Care: A Comprehensive Study of Screening Approach for Tribal Women in Sub-Saharan Africa and Asia. Iran J Public Health. 2025;54(10):2151-2160.
