PHONE IT IN
A Cervical Selfie Might Save Your Life
When is a selfie not narcissistic? When it’s used to detect one of the leading causes of death in the developing world. It turns out that cellphone photos are one of the best ways possible to effect early diagnosis.
Taking shots of your junk with your cellphone might seem inadvisable at best, but in the developing world, cervical selfies can save lives.
Cervical cancer is responsible for the deaths of more than 270,000 people annually, about 85 percent of whom live in low- or middle-income countries, and it is a leading cause of death in developing nations. Unlike many other medical conditions, though, cervical cancer is relatively easy to identify and treat. Researchers found that death rates from the disease the World Health Organization calls “one of the world’s deadliest—but most easily preventable—forms of cancer for women” decreased between 20 percent and 60 percent after women began to be screened for cervical cancer (PDF).
“There’s no reason a woman should die of cervical cancer just because of the fact that she’s not screened on time,” said Ariel Beery, the CEO and co-founder of Tel Aviv-based startup MobileODT, which makes and sells a small, easily portable, and relatively cheap version of a magnification instrument called a colposcope. “So what we do is make sure that woman gets screened on time.”
In the U.S., cervical cancer rates have been drastically reduced thanks to routine Pap smear screening, but that requires a health care infrastructure too often lacking in other parts of the world, particularly in rural areas. What are increasingly prevalent, on the other hand, are mobile phones, including smartphones: those small machines whose highly developed built-in imaging technology, in the form of cameras, has become so commonplace that most of us rarely think about the power we hold in our pockets and the outsize effect it can have around the world. MobileODT has sold more than 150 mobile colposcopes so far that integrate with smartphones to detect cervical cancer, for use in Kenya, Nicaragua, Haiti, and more than 15 other countries.
One country where doctors have been trained to use the cellphone-enabled mobile colposcope is Afghanistan. But the device might never have reached the Afghan city of Jalalabad, on the border with Pakistan, had it not been for an Iranian-raised former nurse from San Diego named Fary Moini.
Moini, who grew up in the southeastern Iranian city of Jiroft, moved to the U.S. in 1983. After the 9/11 attacks she saw a television news clip showing an Afghan woman holding her daughter’s hand as they fled toward the mountains. “We have to find a safe place,” Moini recalls the mother saying in Persian. It was this link to her own language—the Afghan and Iranian variants of Persian are mutually intelligible—that pushed Moini to volunteer at a refugee camp near the Afghan-Pakistani border.
Moini, who is 56, has been to Afghanistan 25 times since 2002 representing the La Jolla Golden Triangle Rotary Club, helping to set up a new school in Jalalabad that now has more than 7,000 students. In November, she flew to Tel Aviv to be trained by MobileODT in how to use the mobile colposcope, then flew to Turkey to share her training with four female Afghan doctors and a technician and to give them cancer screening devices for two hospitals in Jalalabad, along with donated fetal monitors from another company. Cancer screening is set to begin there soon.
“We are hoping with this step, at least it’s a start to make women aware that there is a possibility of a cure,” said Moini. “That is what the significance of this little gadget is.”
In addition to screening for cancer, the device is also helping spread awareness of the disease, and of women’s bodies. “We have to break the taboo,” said Moini. “Culturally, women are ashamed of even talking about their body parts.”
The cervical selfies spread body consciousness beyond Afghanistan. It was at a flower factory in a remote agricultural area of Ethiopia that Ellen Starr saw firsthand that educating women about their own bodies was an unexpected benefit of screening them for cancer.
Starr is a women’s health nurse-practitioner and the clinical director of Grounds for Health, a Vermont-based aid organization that works to diagnose and treat cervical cancer in Latin America and Africa. The aid group started using the MobileODT devices last spring, and when Starr joined a trip to Ethiopia in October, she saw women gathering in the factory lunchroom to peer at photos of the bright-red cervixes on the (male) community coordinator’s iPad after a round of cancer screening. “What we found as a side advantage,” said Starr, “is that women really like seeing their cervixes.”
At the moment, most of the Grounds for Health screening of women aged 30-49 is being done by local health providers who wash the cervix with vinegar and look for white lesions with the naked eye, with the mobile colposcopes reserved for quality assurance and remote feedback on those findings. The NGO treats women with lesions the same day to ensure they don’t fall through the cracks. Starr said she would ultimately like to be able to give a mobile colposcope to all their local health providers—there are 410 of them in four countries—so they can consult with local experts and referral facilities for second opinions, as well as collect data on the results and keep track of patients with abnormal findings.
Starr notes that screening would be essential even if programs vaccinating girls and young women against Human Papillomavirus (HPV), the virus that causes the disease, are highly successful. “It’s going to be 30, 40 years before we can eradicate cancer through vaccination,” she said. “It will be wonderful when we do, but in the meantime we don’t want to lose all those people who are beyond vaccination age but could still develop cancer.”
The idea for using existing cellphone technology as part of a cancer-detection system came from David Levitz, a biomedical engineer who specializes in optics. Levitz, who co-founded MobileODT with Beery in 2012 and serves as its chief technology officer, was building optical equipment at a university lab when he began wondering why such big, expensive instruments were in demand when the smaller, cheaper cameras used in cellphones were everywhere. He eventually helped design the mobile colposcope. But why pair it with a cellphone?
“You’re getting a much better camera with much better specifications [on smartphones] than you are on this expensive medical device,” said Levitz. “It seems counterintuitive, but there’s just so much more innovation happening on the phone side that the phone cameras are just better, and going to get much better.”
The next steps for MobileODT, which won the 2015 MedTech Innovator competition and has raised $3.3 million from a combination of prizes, grants, and funding from angel investors including Mark Cuban of “Shark Tank” fame, are geared to the U.S. market: launching a next-generation “smart colposcope” and using the cancer screening device to document sexual assault—and potentially help convict rapists.
The same imaging system used to screen for cancer is part of a pilot program in which U.S. hospitals use the mobile colposcope to provide visual documentation of genital injury resulting from sexual assault. Used in conjunction with a rape kit to collect semen and other forensic evidence, the imaging device can be used both for consultation with other medical experts and, ultimately, as evidence that could help put rapists behind bars.
Research has shown that there can be a big difference in the extent of genital injury observed by medical staff, ranging from 5 percent of the time, when the genitals are examined with the naked eye, to 87 percent, when a colposcopic technique is used, according to a 2007 review in the journal Trauma, Violence, & Abuse. And forensic evidence of injury has consistently been shown to play a significant role during criminal justice proceedings, from the victim’s decision on whether to report an assault to the decision to prosecute and, ultimately, to convict, the study found.
“Our experience is that images are helpful to make the case, particularly when injuries are severe,” Marilyn S. Sommers, the study author and a professor of medical-surgical nursing at the University of Pennsylvania School of Nursing, told The Daily Beast. She did express reservations about potential security and confidentiality issues for the sexual assault application, but MobilODT’s Beery, who previously helped found the social entrepreneur accelerator PresenTense, said the sexual assault documentation system comes with custom-built software aimed at capturing evidence securely and demonstrating an established chain of custody.
Whether the mobile colposcope is being used to screen women in developing countries for cervical cancer, educate them about their bodies or help women in the U.S. put their rapists behind bars, it all comes down to one concept: “Basically,” said Fary Moini, “a smartphone is going to save women.”