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Telecolposcopy may help reduce barriers to diagnosis of cervical cancer among rural women

Poor, minority, and rural women are more likely than other women to develop cervical cancer. Unfortunately, some women are reluctant to follow up abnormal Pap smears with further evaluation by traditional colposcopy (examination of vaginal and cervical tissue by means of a magnifying instrument) to detect cervical cancer, especially if they have to travel long distances for the procedure, which is often the case for rural women. Telecolposcopy, which allows local doctors to confer with distant experts by transmitting the image of the on-site colposcopy, may help solve the travel problem for rural women, according to a study that was supported in part by the Agency for Healthcare Research and Quality (HS08814).

Medical College of Georgia researchers, led by Daron G. Ferris, M.D., examined the efficacy of telecolposcopy for women with abnormal Pap smears or other indications for colposcopy who were examined by local colposcopists at one of two rural clinics.

The researchers transmitted images of the colposcopic examination to a tertiary care center for interpretation by an expert colposcopist (who televiewed the procedure but did not talk to the local doctor unless asked for consultation). Another colposcopist (site expert) in attendance at the rural site also examined the same patients but did not share findings with other colposcopists.

Local colposcopists sought consultation with distant experts (telecolposcopy) for 36 percent of examinations, which otherwise might have resulted in referrals to experts who typically are scarce in rural areas. Diagnostic accuracy (agreement with cervical tissue findings) was maintained with telecolposcopy. Agreement ranged from 60 percent for local colposcopists and 53 percent for site experts, to 56 percent for distant experts and 50 percent for distant experts who viewed the exam via later videotape (which may have degraded the image). However, the distant experts reported a significantly lower percentage of adequate examinations (60 percent) compared with local colposcopists (76 percent) and site experts (74 percent).

See "The efficacy of telecolposcopy compared with traditional colposcopy," by Dr. Ferris, Michael S. Macfee, M.D., Jill A. Miller, M.D., and others, in the February 2002 Obstetrics & Gynecology 99(2), pp. 248-254.

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