A simple screening program for oral cancer in a defined geographic area in southern India

Abstract

Background: Community-level surveys of potentially malignant and malignant oral lesions are helpful to accurately determine the prevalence and aid in planning population-based strategies for oral cancer prevention. Objectives: We aimed to assess the disease burden through a systematic oral cancer screening program in a defined semi-urban population in Ranipet district (Tamil Nadu, India). Materials and Methods: A multiphase community-based screening program was conducted by the Ragas Dental College and Hospital, Chennai, India, in partnership with Thirumalai Mission Trust Hospital in Ranipet district (Tamil Nadu, India) in a zone-wise manner from Aug 1, 2018 to Dec 31, 2019. Phase I consisted of screening of those who fulfilled the eligibility criteria; demographic data were collected by trained dentists, following which toluidine blue staining of suspected potentially malignant lesions was done. Subjects whose oral lesions stained positive were referred to a hospital where the staining procedure was repeated for confirmation, and then biopsy was done for all subjects by a trained dentist. The subjects were followed up, and appropriate referrals were initiated for all the subjects based on their diagnosis. Descriptive statistics were used to analyze the distribution of potentially malignant cases. Sensitivity, specificity, and predictive values were calculated for the clinical diagnosis using the histopathologic diagnosis as the gold standard. Results: A total of 1389 tobacco users (1012 [72.9%] men) and 3140 non-tobacco users were evaluated. Among them, 194 (14%) demonstrated clinical abnormalities in their oral mucosa; 157 required follow-up and were referred. Of the 157 referrals, 140 (89.2%) went for follow-up, and 84 (64%) of them required biopsies. Of the 74 eligible biopsies examined (7 dropped out and 3 biopsies were rejected due to inadequate tissue), 1 had definite malignancy (1.4%), 41 (55.4%) had potentially malignant oral disorders, and 32 (43.2%) had non-specific features. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the clinical diagnosis made at the screening program were 88%, 25%, 61%, and 61%, respectively. Conclusion: Systematic visual oral screening restricted to high-risk individuals is a worthwhile initiative for the detection and control of oral cancer. Visual screening and early detection of premalignant oral disorders has the potential for early detection of potentially malignant and malignant oral lesions, and thus could play a pivotal role in disease control and improving patient outcomes. (Partial funding provided by the University Research Committee, The TN Dr. MGR Medical University, Guindy, Chennai; and the Thirumalai Charitable Trust, Ranipet, India)