#Brazil: Evaluating the Viability of the Callascope

Erica Skerrett

Overview Today is my first day here in Sao Paulo, and I met up with Luiza, who if the Hart Fellow working with the Callascope and barriers/viewpoints on cervical cancer screening in Brazil. Luiza introduced me to some of the FOSP (Fundação Oncocentro de São Paulo) administration, including the research director and their social worker who supervises studies in the clinical sites around the city. Their current aim is to see if HPV testing can be introduced into the cervical cancer screening paradigm in Brazil—their research has helped inform Brazil’s national guidelines. (See https://cancerpreventionresearch.aacrjournals.org/content/12/8/539.abstract for some of their results!) Lewis, a master's student studying HPV screening, was also able to join the meeting.

Many women don't follow up with colposcopies who need them, while many women who don't need colposcopies are getting them Lewis had a really interesting perspective from studying access to colposcopy for patients with abnormal cytology or high risk HPV. In his study roughly 80% of those patients came in for a colposcopy follow-up, but in the larger population this number is believed to be less than 20%. On the other hand, many more people are getting colposcopies even if they don't have a positive pap smear--this is because they may refer a patient to colposcopy whose pap smear shows inflammation or because, often times in private clinics, providers will perform a colposcopy at the same time as a pap smear.

We still need to explore Brazilian women's willingness to self-screen We also touched on women's willingness/openness to self-insert the Callascope, and how that may depend on education, tampon usage, and access to privacy (which can be based on income). I mentioned how a graduate student from our lab explored this in Ghana, and she experienced that women were very interested in self-inserting the Callascope after hearing about the experience from their peers. (The research director recounted a study from the 80's in which women were asked to draw their anatomy and then they visualized each other’s anatomy during a pap smear. Only about 1 of 100 women refused to take part in the visualization process. What's interesting is that there was a similar breast exam study that was performed, in which women would perform a breast exam in front of a mirror alongside other women. Most women refused to do this, and one theory is that there were already standards for beauty with breast anatomy/size that made women self-conscious, compared to vaginal anatomy which was more unknown and therefore likely to be explored.) I learned that the president of FOSP is interested in beginning a self-HPV study, and so that would be really interesting in terms of learning more about women's openness to self-exams in Brazil.

We set up plans to talk to an expert in colposcopy at a public hospital Lewis, Luiza, and I are scheduling a visit to a Santa Marcelina hospital, where we should be able to talk to an expert in colposcopy. One thing that we discussed was the best way to go about introducing the project because we realized that people’s first impression is to see the Callscope as a method to replace colposcopy exams, which isn’t the case. We want to present the interview as (1) We are interested in the knowledge on colposcopy exams and cervical cancer and (2) in how the device can be applied in their reality to make the screening process more effective. We see the Callascope (potentially coupled with HPV testing) as a way to help lead the right people to the colposcopy exam and biopsy, as a way to address the 2 paradoxical groups that Lewis referred to who are either over- or under-screened.