April 13, 2018
In most parts of the world today, women are advised to get screened regularly for cervical cancer. But not all do, including some women in resource-challenged areas of the United States.
The authors of a new study published in the April 2018 issue of the >Journal of the National Cancer Institute describe the power of automating the process to help get the job done.
Their approach: to use a completely automated system to interpret Pap test results.
The Pap test itself, in which a sample of cells is collected from a woman’s cervix, would still need to be done by a human being. After that, however, computers, not humans, would look at and interpret Pap test results and also perform the next step, called triage, to designate which women should be funneled for further testing to see whether abnormal Pap test results indicate cervical cancer.
“I think this is the future, definitely,” says Kathleen Schmeler, MD, associate professor in the department of gynecologic oncology and reproductive medicine at MD Anderson Cancer Center in Houston. “Maybe not this exact thing but more of artificial intelligence in medicine in general.”
“The most important thing is they are automating the Pap test read, which means that it would allow for high-quality Pap tests everywhere, especially for parts of the world where Pap tests aren't available because there isn’t anyone available to read them accurately,” Dr. Schmeler says.
Schmeler adds that while these findings are tantalizing, there’s a very effective vaccine for the primary cause of cervical cancer. “The most important prevention method we have is still HPV vaccination,” she says.
Nearly all cervical cancers are caused by the human papillomavirus (HPV), and 70 percent of these HPV-related cervical cancers are tied specifically to HPV types 16 and 18, according to the National Cancer Institute.
Margaret Long, MD, gynecologist at the Mayo Clinic in Rochester, Minnesota, calls the study findings promising and agrees that, for the moment, they are weightier for the rest of the world than for the United States.
“I think the timeline for use in the United States is longer because we have a system that works pretty well. It's not perfect. But it works pretty well,” Dr. Long says.
RELATED: >What Are HPV 16 and 18?
>What Are HPV 16 and 18?
What Automating Cervical Screening and Triage Look Like
Most cervical cancer screening programs in the United States today combine conventional cytology methods — in which a lab technician or pathologist looks for changes in the appearance of cervical cells (taken in tiny amounts from the surface of a woman’s cervix) — with an HPV test to check for the virus itself in cervical cells. Results determine which women should get triaged for a diagnostic procedure called a colposcopy.
Reviewing Pap tests by hand requires a fair amount of skill and is pretty labor-intensive. Study authors describe using an automated system to find precancers in such a way that matches the skill and accuracy of the people who now do this.
Using a special algorithm, the researchers captured images taken from slide scans containing cervical cells. A severity rank score was then generated, to designate which women should be further examined and possibly treated and which should be rescreened in a year.
Implications for Women Across the United States
By allowing for the extension of very high-quality cervical screening and triage to underserved regions of the United States, Schmeler says that automation such as this could hopefully end some of the health disparities that exist today.
“One of the things we know about cervical cancer is that it's far more frequent in medically underserved populations and in minority populations,” she says. This is the case along the Texas-Mexico border, for example, “where the cervical cancer rates are 30 percent higher than the rest of the state because we have fewer providers and physicians and nurses. Also, people just don't have access to healthcare because of lack of insurance, lack of money, lack of health literacy.”
Schmeler sees the possible benefits of automation extending to women who have no problem accessing quality care, too. “I think with time and with further study, there's the potential that you could get more accurate and consistent results, and maybe one day also faster results,” she says.
That helps everyone, no matter where they live or what level of resources they have.
Another sweet spot for automation, Long adds, is the intellectual capacity that the machine can take on rather than a human being. Screening can be very complicated, she says, with pages and pages of algorithms to sift through to figure out what to do with a certain combination of test results.
There’s even an app for this now, she says, because it's too complicated to just remember it all. “So one of the things that’s attractive with a completely automated system," she explains, "is you don't have to have somebody intellectually process it all.”
Source : https://www.everydayhealth.com/cervical-cancer/automated-screening-cervical-cancer-fast-accurate/