Telemedicine services are rapidly becoming an integral part of many hospitals and rural clinics around the world and are perceived as having great potential for accessing underserved populations. Although the mortality from invasive cervical cancer in the US has declined over 50% during the past 40 years, likely due to aggressive screening programs, the decrease has not been as dramatic among minority populations and rurally located populations. The Arizona- Sonora Binational Commission has identified cervical cancer prevention as a high priority for Hispanic women. Since the majority of patients with frank cervical carcinoma and cervical dysplasia, its precursor lesion, are asymptomatic, Pap smear screening provides the best approach to early detection. Patients with an abnormal Pap smear and no visible lesion on visual cervical inspection are referred to colposcopy. The colposcope is a magnifying instrument that can directly detect dysplastic lesions of the cervix. Once visualized, the lesion can be biopsied and a tissue diagnosis can be made. Telecolposcopy allows for the collection and transmission of digital cervical images via telecommunications technology. Telecolposcopy can be performed live, in """"""""real-time,"""""""" with direct communication between the colposcopist and the telecolposcopist, or the telecolposcopist can review the images at a later time via store-forward technology. The use of telecolposcopy provides a means for rural women to access this specialized care without being burdened by usual constraints includingtravel, time off from work due to travel and costs due to travel such as arrangements for child and elder care. Pilot data from a university tertiary care colposcopy clinic demonstrate that the efficacy of telecolposcopy is comparable to that of colposcopy. This study will build on the pilotdata by examining the feasibility of telecolposcopy outside of a tertiary care setting. The central hypothesis of this proposal is that telecolposcopy will be as clinically effective as in.person colposcopy in the assessment of the cervix after an abnormal Pap smear. The secondary hypotheses are (a) patients, their providers, and the telecolposcopists will be satisfied with telecolposcopy services and (b) telecolposcopy can be integrated into a primary care women's health clinical practice in a cost effective manner. The proposed study will result in the improved management of cervical lesions for women with decreased access to telecolposcopy services.
