Given that it’s Gynecologic Cancer Awareness Month, with cervical cancer claiming its spot as the most common of these cancers, I began to wonder what the app world is doing for awareness and prevention.
Better and more sophisticated applications for diabetes monitoring seem to appear fast and furious these days, with new and more innovative applications for asthma filling the app store, and more mood-tracking apps than even I can try out. But what can be done for an illness where we specifically don’t want monitoring, where the biggest name of the game is never giving it a foothold in our bodies at all?
Well, the mobile health world won’t let us down–at least not in making its presence known. There are currently two free apps available for iPhone that deal with the issue of cervical cancer, each from somewhat of a different angle.
The rather awkwardly named Cervical Cancer Prevention & Screening Information app (that’s a mouthful!) was developed by the National Association of Nurse Practitioners in Women’s Health, which represents nurse practitioners who provide care to women, and thus clearly focuses on issues of interest to females–just like cervical cancer.
Their mission statement tells you that their goal is “to assure the provision of quality health care to women of all ages by nurse practitioners. NPWH defines quality health care to be inclusive of an individual’s physical, emotional, and spiritual needs.. . .NPWH is a trusted source of information on nurse practitioner education, practice, and women’s health issues. NPWH works with a wide range of individuals and groups within nursing, medicine, the health care industry, and the women’s health community.”
So back to the app. It isn’t aimed at patients at all, interesingly enough, but is rather a tool for health care providers to “review strategies for cervical cancer protection for girls and women.”
The app opens with a set of talking points, which it calls ‘Practice Points,’ for clinicians. They seemed fairly self-explanatory, to be honest, but I gave benefit of the doubt that perhaps a quick review never hurt doctors. They include ideas such as “explain HPV in clear, simple language.” Sounds good. Another not-so-brilliant one is “ask if your patient smokes,” but the tip to “administer the first shot immediately after the consultation” seems pretty wise to me, knowing how many women get cold feet when they think about the convergence of shots and private body parts.
It then has the clinician select an age group, and provides relevant information. For example, if you select the image of the 9-10 year old, you’ll find that “The FDA has approved the HPV vaccine for girls and women ages 9 to 26,” under 13-19 you discover that “HPV vaccination is part of childhood disease prevention,” and “the CDC recommends catch-up vaccinations for this ge group using the same formulation for the full series.” 27-29 brings you to information that vaccine is not indicated for this age group, but the clinician should “determine the status of cervical precancers or cancer by scheduling Pap tests at recommended intervals.”
The oldest age group–and I found this mighty depressing–is listed as “30+.” That seems to cover a whole lot of territory if you ask me. There you’ll find that cervical cancer is most common in women age 30 and older.”
There’s a few–like two– links, like The “NPWH GUidlines for Cervical Cancer Screening,” which I’ve hooked you up with right here, sparing you time with this app–and that’s about it.
Although I’m quite glad the app exists if there’s a need for it, I’m faintly alarmed that actual clinicians need this information provided them in an app. I mean, isn’t this common knowledge for people who treat women? Is this app filling a gap in information in our healthcare providers, and if so–how, in heaven’s name, can that be?
I didn’t close the app with a surge of confidence that, yes, mobile health will chance the face of female healthcare. So I was a bit trepidatious about app number 2.
The Pap Guide App lets you know before you even can ‘get started’ that “the Pap Guide App pulls together and presents guidance on screening for cervical cancer. . . .The main source of guidance is the 2012 ASCCP et. al. consensus guideline supplemented by guidelines from ACOG, the US Dept. Health & Human Services, and more.”
I figured that all those initials make it sound promising at least, as if it’s not addressing a group of people who haven’t even heard of the most basic terms.
When you do get past that ‘get started’ hurdle, you’ll find three subsections: Patient Age or Circumstance, History of the Pap Smear, and HPV Facts.
I found the History of the Pap smear section fascinating–did you know that the Pap smear was innovated by an assistant professor of anatomy who really just wanted to study guinea pig eggs at mitosis, and had to find out when the aforesaid pigs were about to ovulate? And that his first findings on ‘vaginal smears’ (this is after the guinea pigs, and well into human terrain by now) were viewed with “skepticism and disinterest”? Also fascinating: the Pap smear is the most wisely used cancer screening test in the U.S. Additionally, cervical cancer, mainly due to the Pap, has fallen from the number one cause of cancer death in women to number 14.
Really, I got my money’s worth (which was, now that I mention it, precisely nothing–it’s a free app), just in this section–but of course it’s really only useful one time, and a Google search could have come up with that interesting guinea pig genesis probably just as well.
So because I’m a softie for history and unique facts, I went to the HPV facts section next, only to discover that–and I’ll bet none of my readers knew this–HPV subtypes 18 and 16 are the most carcinogenic, and–here’s one that you can spout out at dinner parties, making you sound highly educated: “HPV is a virus that can infect the keratinocytes of human skin or mucous membranes.” The keratinocytes, huh? Try finding that word in Boggle.
But really, up to this point, the app provides information that either I once again count on my provider knowing–or information that’s intriguing, but not directly relevant to the type of care one provides. I was losing hope in the promise of cervical cancer apps.
The app’s last chance to earn its salt came in the “Patient Age or Circumstance” tab, where women are divided into age groups, and circumstances of “post-hyterectomy, ” “pregnant,” “HIV positive,” and “HPV-vaccinated vs. unvaccinated.”
And here’s where I felt this app had it all over Cervical Cancer Prevention & Screening Information app. When the clinician selects by age or circumstance they are informed whether or not to screen, what normal Pap results should be, what to proceed to do if the Pap doesn’t come back just right, and has helpful tips that I could see a clinician needing to reveiw , such as if it’s “Pap Agus or AIS: proceed to Colposcopy.” Why not Endometrial Biopsy you might ask (or you might if you were a doctor, which is really the point)? Not recommended–except in cases of morbid obesity, oligomenorrhea or chronic anovulation. Now those are fancy terms that make me think this app really could be aimed at a practicing clinician–not someone who seemed to have wondered in out of medical school without knowing about the HPV.
You can find out that someone 21-29 with an ASCUS pap should be rescreened in 3 years if they’re negative for HPV, but should be sent straight to a Colposcopy without passing go if they’re positive for HPV.
In short, it seemed an app a clinician could find useful, even if they had a clue about best practice in gynecological healthcare already.
So I discovered, in my search for cervical cancer apps that:
1. There are none for the lay-person. This seems an area ripe for development.
2. The apps both include enough very basic information to make me question why competent healthcare providers would need those parts of it. The Cervical Cancer Prevention & Screening Information app seemed to be redundant in a world of clinicians who work with women–or at least one would certainly hope so.
3. But the Pap Guide App seemed geared at clinicians who were capable, but needed a quick review of best practice in any given situation, and as such had more to offer. I mean, not everyone knows that you should screen a women post-hysterectomy if she has “a cervix after supracervical hysterectomy.”
That’s precisely the reason this app inspires more confidence that app developers can create products that further the treatment and management of a disease, no matter how difficult it might seem to be to monitor that illness remotely.