Cervical Cancer Screening Outcomes Using Smart Scope Among Rural Women in Pune District, India : A Cross-Sectional Study with Multivariable Risk Modelling

Background Cervical cancer remains the second most common cancer among women in India. Screening programmes are effective, but implementation in resource-limited rural settings is hindered by infrastructure, workforce and follow-up constraints. Methods A retrospective cross-sectional study screened 1,747 rural women above 18 years 0f age at rural field practice area of private medical college, Pune, from January 2023 to December 2025. Data of cervical cancer screening were collected using Smart scope. High resolution cervical images were captured by trained medical officer and interpreted by gynecologist. Mean age differences across pathology groups were assessed with one-way ANOVA and Bonferroni-adjusted pairwise comparisons. Linear trend in erosion prevalence across age groups was tested using the Cochran–Armitage test and a fitted linear regression trend line. A multivariable binary logistic regression model was fitted for cervical erosion. Model discrimination was assessed by the area under the receiver operating characteristic curve (AUC) and calibration by the Hosmer–Lemeshow test. Results Of 1,747 women screened, 61.1% had a healthy cervix, 35.7% had cervical erosion, 2.6% had a cervical polyp and 0.6% had a mixed infection. Age was significantly associated with screening outcome (χ2 = 64.23, df = 6, p < 0.001), and erosion prevalence declined near-linearly from 47% in women aged 20–24 years to under 20% in those aged ≥ 65 years (Cochran–Armitage trend Z = − 6.73, p < 0.001; linear trend p < 0.001). Mean age differed significantly across pathology groups (ANOVA F = 21.19, p < 0.001); women with polyps were oldest (44.72 ± 9.08 years) and those with mixed infection were youngest (34.91 ± 8.46 years). On multivariable logistic regression (n = 1,676; full symptom model), younger age (adjusted OR [AOR] = 0.97 per year, 95% CI 0.96–0.98), backache (AOR = 1.51, 95% CI 1.19–1.91), white discharge (AOR = 1.45, 95% CI 1.15–1.85) and later age at menarche (AOR = 1.08 per year, 95% CI 1.01–1.16) were independently associated with cervical erosion (model AUC = 0.648; Hosmer–Lemeshow p = 0.24, indicating adequate fit). Conclusion Smart Scope-assisted screening identified a substantial burden of cervical pathology among rural women, with age and specific symptoms independently predicting cervical erosion. Symptom-triggered and age-stratified screening, supported by portable digital imaging and telemedicine, may strengthen early detection in resource-limited rural settings.