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)
In a defined geographic area in rural India (1,60,000 population), osteoporosis detection and calcium and vitamin D supplementation program was instituted. Of the eligible 15,386 subjects, 5,992 (38%) participated in the program; 2,882 (48%) had osteopenia and osteoporosis; supervised calcium and vitamin D supplementation was instituted; 2,113 (73.3% of those identified) completed 2 years of supplementation. The mean duration of the follow-up was 5 years (range 2–8 years). On follow-up, three groups emerged; those who were regular, those who were irregular, and those who did not take supplements. In those who were regular with calcium and vitamin D supplementation, we found a significant reduction in fractures (RR 0.27, 95% CI 0.09–0.81) compared with those who did not take supplements. There was no significant difference in falls between the three groups. Mortality was significantly lower (RR 0.53, 95% CI 0.31–0.91) in those who were regular with calcium and vitamin D supplements compared to those who did not take supplements. While the reduction in fractures was probably due to calcium and vitamin D supplementation, the reduction in mortality was probably because those who took regular supplements accessed healthcare services more readily for other comorbidities as part of their follow-up program.
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