# Earth Mover's Distance-Based Tool for Rapid Screening of Cervical Cancer Using Cervigrams
## 4 Discussion  
An estimated 90% of the globally recorded cervical cancer-related deaths are in low- and middle-income countries (LMICs). Cervical cancer is a public health problem in LMICs such as India, so much so that India alone accounts for one-quarter of the worldwide burden of cervical cancers [19]. It is estimated that cervical cancer will occur in approximately 1 in 53 Indian women during their lifetime compared with 1 in 100 women in more developed regions of the world [20] due to the availability of efficient and accessible screening programs as well as diagnostic and treatment facilities. Apart from the preponderance of HPV infection, a variety of clinical-epidemiological risk factors such as early age of marriage, promiscuous sexual behavior, multiple pregnancies, and poor genital hygiene along with aberrant lifestyle choices such as smoking are known to be associated with increased risk of cervical cancer. The results obtained from our data indicate that a lack of adequate knowledge about the adoptive reproductive and sexual health practices is indeed responsible for increasing the vulnerability of women to cervical cancer. Successful implementation of this strategy will have a positive impact on not only understanding the niche-specific drivers for onset and pathological sequelae of cervical cancer but also on providing the rationale for developing novel precision-oriented niche-specific non-linear predictive algorithms for early clinical diagnosis as well as prioritizing the delivery of treatment options to high-risk patients afflicted with cervical cancer. The adoption of low-end mobile health-based applications to propagate Internet and communication technology (ICT)-based awareness about cervical cancer might not only contribute to overcoming region-specific social stigmas and taboos associated with the prevalence of cervical cancer but also facilitate remote connect of cancer afflicted patients with the treating physicians. The etiopathogenesis of cervical cancer is unique; as a consequence, its characteristics pertaining to different symptoms and parameters necessary for disease labeling, tagging, and further diagnosis are unique and community-specific or niche-specific. One of the biggest challenges is increasing the accuracy of the digitally acquired images, which in turn pertains to low-resolution optics prevailing in coloscopes along with the noise and artifacts such as blood and haziness in the certifgrams (in our case, the MobileODT coloscope had a 13 Megapixel resolution, which needs improvement to visualize cervical cancer lesions more clearly) and to the lack of optimal oncological image/video processing algorithms for outlining a correct set of parameters [21; 22]. Some progress has been reported in the histological image of cervical cancer by [PERSON] et al. [23], where multi-level set-based image processing techniques and deep learning has been used to outline cell nuclei. Our work should be looked at as complementary or even advanced effort to analyze cervical cancer certifgrams at the normal optical scale, obviating the need for sophisticated microscopy equipment and hence making early cervical cancer detection accessible to economically weaker sections of the society. Modern efforts to leverage the artificial intelligence capabilities in resolving the cervical cancer issue are reported continuously [24]. Disease-labeling of cancer is a data-intensive and rigorous task that requires accurate and specialized expertise. These skills are not readily available particularly in remote areas with limited healthcare infrastructure. The prevalence of misdiagnoses and missed diagnoses is high in the absence of portable, accurate, and robust diagnostic tools [22], where our proposed tool could aid medical professionals in drastically improving the detection of cervical cancer at an early stage. One of the strategies for ensuring early detection of a cervical cancer lesion pertains to large-scale rapid screening for the disease in PHCs.