Breaking Down Barriers to Cervical Cancer Screening

The POCkeT Colposcope being developed at Duke is designed to make cervical cancer screening easier and  more sustainable in low- to middle-income countries.

Researchers from Duke Cancer Institute, Duke Global Health Institute, and other areas across Duke are developing the device.


Cervical cancer is very treatable when caught early. But, in 2012, more than 270,000 women died from the disease. Most of those deaths were in low- and middle-income countries. One reason—many women don’t get screened, either because of lack of health care resources or because of the stigma associated with a pelvic exam in some countries.

Duke Cancer Institute member Nimmi Ramanujam, PhD, Professor of Biomedical Engineering and Global Health, and John Schmitt, MD, Professor of Obstetrics and Gynecology and Global Health, are working to change that by developing a portable screening device.

Called the Point of Care Tampon, or POCkeT Colposcope, the invention is a miniaturized version of a colposcope, which uses magnification and two different kinds of light to identify cervical cancer. Though miniaturized, the new device has comparable performance to a state-of-the-art digital colposcope that is used in the United States to further screen women who have abnormal pap smears, says Marleee Krieger, research project manager in Ramanujam’s lab.

“Our hope is that our system is so easy to use and so portable that women won’t have to go to a tertiary medical center to be screened. They can be screened in a local health care center by a trained health care worker or a nurse with technology that provides state of the art visualization,” Krieger says.

When connected to a laptop or mobile phone, the device can send images to consulting doctors. Collaborator Lavanya Vasudevan, a visiting scholar at Duke Global Health Institute, is developing an accompanying app that can be used to mark suspicious areas on images, schedule patients, and keep electronic medical records.

The team’s first goal is to compare results from the POCkeT Colposcope against test results from standard-of-care screening with a full-size colposcope. They’re doing that now in a study with 100 women in the United States. In the next two months, the team will begin a similar study with patients in Peru.

Duke Global Health Institute is developing an app to be used with the pocket screening device.


In coming years, the team will add a feature that will eliminate the need to use a speculum, which means that a woman could insert the device herself to take an image that could be sent to a doctor for screening.

“Even in the United States, women have a fear of the speculum,” Krieger says. “So obviating the need for the speculum removes a significant barrier to screening.” In some other countries, that fear is coupled with cultural stigma; men may not let their wives go for a cervical cancer screening because they don’t want their wives to be undressed in front of a male physician, or because they fear she will become less of a woman because of the screening.

The team is working with people from industry as well as many disciplines across Duke to determine the best way to manufacture and distribute the device in particular areas. “We can’t just make technologies for low-resource settings,” Krieger says. “We have to make a technology that’s culturally appropriate. So we’re trying to do a total analysis of each stage to figure out what is actually going to make a sustainable impact for women in these countries.”

The team is developing the device thanks to $3.7 million in grants from the National Institutes of Health. —Angela Spivey