The role of digital screening solutions for cervical cancer

• Cervical cancer screening enables the early detection of cervical cancer, significantly increasing the chances of successful treatment and survival
• Digital screening solutions for cervical cancer could enhance access and adherence to the latest cervical cancer screening guidelines, improving patient care and healthcare efficiency
• By optimizing screening processes, data-driven digital tools could lead to cost savings for healthcare systems

Despite significant medical progress, cervical cancer continues to be a significant public health challenge, affecting over 600,000 women and causing 340,000 deaths globally in 2020.¹ The impact of the disease has resulted in 210,000 children losing their mothers, underscoring the urgent need for effective prevention and treatment strategies.² Barriers such as limited screening access, late diagnosis, economic hardship, and cultural norms are hindering efforts to combat cervical cancer.³

Addressing these obstacles requires the implementation of more holistic and comprehensive prevention and control programs.^3,4,5 The World Health Organization’s (WHO) ambitious 90-70-90 targets for eliminating cervical cancer by 2030 highlight a strategic approach incorporating vaccination, screening, and treatment. Digital health technologies play a pivotal role in this strategy, offering innovative ways to improve access to services, screening efficiency, and the delivery of timely care to women globally.⁶

The economic implications of achieving the WHO’s targets would be profound, promising a return of approximately $3.20 for every dollar invested by 2050, attributed to increased participation of women in the workforce. This investment could lead to significant societal and economic benefits, with about 250,000 women potentially remaining in the workforce and contributing an estimated $28 billion to the global economy.⁶

This article delves into the health and economic benefits of digital health, which could result in enhanced guideline compliance, and optimized screening workflows, as well as a contribution to the reduction of cervical cancer’s burden.

The burden of cervical cancer is particularly high in low- and middle-income countries (LMIC), where incidence rates are nearly double and mortality rates are triple those observed in high-income countries. The disparity is primarily attributed to gaps in the availability and quality of cervical screening programs and the accessibility to effective treatment for invasive cervical cancer.

Screening for cervical cancer plays a crucial role in reducing the burden of cervical cancer by enabling the early detection and treatment of precancerous lesions. High-performance HPV testing, recommended as the primary screening method, offers superior specificity and the advantage of extended screening intervals due to its high negative predictive value. Incorporating self-sampling can further increase the accessibility and acceptability of screening services.⁶

Recent analysis underscores the significant impact of the WHO’s 2021 updated cervical screening guidelines in LMICs, particularly the crucial role of primary HPV screening in diminishing the cervical cancer burden. Without screening, a cohort of 100,000 unscreened women in 78 LMICs could face 1,950 cervical cancer cases and 1,456 deaths. By implementing primary HPV testing every 5 years for 30 to 50-year-old women, the age-standardized incidence rate was estimated to decrease by 57% and the mortality rate by 67%. By achieving the 2030 triple-interventions targets in 78 LMIC countries,  a total of 74.1 million cancer cases and 62.6 million deaths worldwide would be averted over the century, underscoring the critical importance of aligning with the latest WHO guidelines for global health improvement.

To address the burden of cervical cancer effectively, a comprehensive approach that includes high vaccination coverage, widespread access to high-quality screening and treatment, and the integration of these services into the primary healthcare system is essential. This approach also requires overcoming social and cultural barriers, enhancing health literacy, and ensuring equitable access to preventive and treatment services across all population groups.⁶

The landscape of cervical cancer diagnostic methods is undergoing a significant transformation thanks largely to the integration of digital technologies and artificial intelligence (AI). The recent global shift towards digital health solutions, particularly highlighted during the COVID-19 pandemic, has opened new avenues for addressing cervical cancer screening and prevention.^9,10

The multi-stakeholder Malaysia’s Program R.O.S.E is an example of innovative digital health initiatives. This initiative harnesses digital health platforms to enable real-time reporting and seamless follow-up care for women, broadening the accessibility and convenience of cervical cancer screening. Program R.O.S.E ensures women are effectively linked to necessary care by integrating self-sampling and digital technology.^10,11

Additionally, digital interventions like Project ECHO employ tele-mentoring to enhance healthcare workforce capabilities, particularly in cancer care. It’s recognized for its “hub and spoke” model, connecting specialists with local practitioners to share knowledge and best practices. This model has notably expanded globally, with over 80 cancer ECHO hubs. This project impacts healthcare knowledge and aims to improve cancer care outcomes.^10,12,13

Moreover, the advent of data analytics tools could offer a deep dive into screening program performance, enabling healthcare providers to tailor interventions more effectively and ensure adherence to screening guidelines.

Implementing digital health solutions in cervical cancer screening programs has the potential to improve health outcomes and offer significant economic benefits. By optimizing screening processes and adherence to guidelines, the benefits of digital health solutions could reduce the incidence of cervical cancer, thereby decreasing the need for costly treatments associated with advanced stages of the disease.^6,7 Certain features such as SMS reminders have been adopted by the NHS Cervical Screening Programme (UK) after a study performed in London showed an increase in adherence to guidelines, with attendance increasing by 4.8% after six months.¹⁵

Health and economic impact models for digital health solutions in cervical cancer screening take a comprehensive approach, considering costs from screening to treatment and potential savings from preventing advanced disease cases. This approach assesses the economic viability and health benefits, emphasizing the importance of digital solutions in enhancing healthcare outcomes and efficiency.

One example is the health economic impact model for implementing a digital health solution in cervical cancer screening for women aged 25-65 in Catalonia. In this model, the local guidelines were considered, and medical and economic factors were included, resulting in the estimation of an annual cost of 12,641,219 euros for cervical cancer without the digital solution.⁷

The costs were divided between cancer treatment, HPV, cytology testing, and colposcopy procedures, with cancer screening constituting the largest portion. The model suggests that adopting the digital health solution could lead to annual savings ranging from 5-20%, depending on the extent of its integration. Specifically, in a scenario where the digital solution’s adoption aligns with the average uptake for similar technologies and the potential for improved adherence is deemed moderate by clinicians, the projected savings stand at approximately 1.65 million euros.⁷

These savings are attributed to cancer treatment averted, testing optimization, and the avoidance of unwarranted colposcopies, with the latter representing the largest saving area out of these three savings areas. The model highlights the potential cost-effective advantages of the digital health solution in cervical cancer screening programs.⁷

Integrating digital health solutions into cervical cancer screening programs represents an important tool in the fight against cervical cancer. By enhancing adherence to screening guidelines, improving patient engagement, and optimizing screening processes, digital technologies could significantly reduce the burden of cervical cancer.^6,9,10 This shift may not only result in better care for women, but also more efficient and cost-effective healthcare systems.⁷

The case for digital health in cervical cancer screening is strong, and as technology continues to evolve, the potential for further improvements in screening efficacy and efficiency is vast. The future of cervical cancer screening lies in ensuring that every woman has access to the best possible care, aligning with global health goals to reduce the incidence and impact of this preventable disease.