A promising technique to improve and expand the practice of colposcopy to help the global fight against cervical cancer

© Annals of Translational Medicine. All rights reserved. Ann Transl Med 2022;10(13):723 | https://dx.doi. org/10.21037/atm-22-2959 Cervical cancer affects women worldwide, although two predominant scenarios are observed. The first occurs in countries that have reduced mortality with organized screening programs and currently are reaching high coverage of human papillomavirus (HPV) vaccination in preadolescents and adolescents (1-3). Based on real-life data, it is already possible to observe and project a progressive drop in both cervical cancer cases and precursor lesions for the next decades (4-6). In those regions, is expected a progressive debate focused on improving screening and diagnosis methods, such as biomolecular tests and colposcopy performance (7,8). The second scenario is related to low and middle-income countries, which account for at least 80% of cervical cancer cases detected annually (9). This higher concentration is due to the insufficient or non-existent provision and access to preventive measures such as vaccination and screening, highlighting the global disparities (10). In those regions, efforts are focused on providing less costly and easy-to-perform methods, and emphasizing high coverage HPV vaccination at early ages. When vaccinating girls up to 15 years of age, a substantial impact is expected to reduce mortality from cervical cancer. The World Health Organization (WHO) has considered vaccination a primary global goal since 2019 (11). Even with scientific evidence and tools already available, there are disparities in technology use among regions. Currently, many women cannot be benefited from early diagnosis and experience a cure for early-stage cervical cancer. They experience barriers such as lack of knowledge, access to screening and diagnosis programs, and facilities. Demonstration studies on organizing screening programs using biomolecular tests showed promising results and costeffectiveness (12-15). Colposcopy is a step in cervical cancer prevention, enabling the diagnosis of precursor lesions or early invasive cancer diagnosis after a positive screening test. It is an outpatient exam usually performed by gynecologists and well tolerated by women after sexual debut. The cervix is visualized and evaluated in detail during a gynecological exam. The colposcope has good lighting linked to magnifying lenses. After applying common reagents on the cervix surface, such as acetic acid or iodine solutions, suspicious areas are identified to guide biopsies or excisional procedures. Colposcopy’s performance depends on adequate equipment and the examiner’s experience, with a nonnegligible degree of subjectivity (16,17). In low-income regions and rural or remote areas, where the prevalence of cervical cancer is usually high, colposcopy is not available. Screening is performed by a low complex test, the ‘visual inspection’ (VI), with lighting and the use of colposcopy reagents, acetic acid (VIA), or compound iodine solution (Lugol’s iodine, VILI), with limited results (18,19). The colposcopy exam has some limitations associated with the colposcope device, colposcopist experience, and the reduced capacity to identify lesions in the cervix Editorial