Follow-up of a decentralized colposcopy program for the investigation and management of cervical intraepithelial neoplasia in the central Canadian Arctic.

Cervical intraepithelial neoplasia (CIN) is the second leading cause of cancer in Canadian Inuit women, and the incidence ratio in this population is 3.1 times the Canadian average. In 1993 a program was developed in a regional northern health center (Churchill) to provide colposcopy and loop electrosurgery for women in the Keewatin District of the central Canadian Arctic. Data collected prospectively over the following 2.5 years are presented. One hundred and forty-six women were seen in 341 visits. Indication for referral included CIN I on Pap smear (54.1%), CIN II (34.9%), CIN III (9.6%), and carcinoma of the cervix (1.4%). Large loop excision of the transformation zone was performed at a rate of 9.7 procedures per 100 patient visits. Estimated travel cost-savings attributable to this northern program are $299,200 (Canadian). Use of portable colposcopy in patients' home communities is presently being considered in order to provide enhanced accessibility and further cost-effectiveness.