A Novel Mobile Health Approach to Early Diagnosis of Oral Cancer

Abstract

Aim: The incidence of oral cancer is high in India, which can be reduced by early detection. We aimed to empower frontline health care providers (FHP) for early detection and connect specialist to rural population through mHealth. Materials and methods:We provided training to FHPs in examination of oral cavity, use of mobile phone for image capture, and risk factor analysis. The FHPs were selected from different cohorts in resource-constrained settings. The workflow involved screening of high-risk individuals in door-to-door and workplace settings, and capture of images of suspected lesions. Uploaded data were interpreted and recommendation was sent by specialist from a remote location. Their recommendation was intimated to FHPs who arranged for further action. Two more initiatives, one for multiple dental schools and another for private practitioners, were undertaken. Results:During the period from 2010 to 2018, 42,754 subjects have been screened, and 5,406 subjects with potentially malignant disorders have been identified. The prevalence of potentially malignant disorders varied from 0.8 to 62% at different cohorts; 516 biopsies have been performed at remote locations. Conclusion:Connecting specialists to rural population was made possible through the use of mobile health. Trained FHP were able to reach out to the population. Electronic data capture facilitated efficient follow-up. The program was very cost-effective with screening completed under $1 per person.Clinical significance: In view of the high incidence of oral cancer in India, and the resource-constrained settings, mobile health paves the way for better access to specialist care for the rural population.

Mobile Health (mHealth) Technology in Early Detection and Diagnosis of Oral Cancer-A Scoping Review of the Current Scenario and Feasibility

“…A rural program called the “mobile-Health model,” where frontline health workers were empowered for early detection and connected to a specialist through mHealth, was found to be very effective in reducing the cost of oral cancer screening to below $1 per person [ 48 ]. The authors trained frontline health professionals to examine the oral cavity capture images using mobile phones and conduct risk factor analysis among cohorts ( n = 42754) belonging to various resource-constrained areas between 2010 and 2018 [ 48 ]. The authors of another study ran training sessions with a mHealth prototype.…”

“…This included significant problem challenges for patients such as difficulty in getting permission to leave work, the expense of traveling, and loss of daily wage when the participants take leave to attend the hospital appointment [ 49 ]. Several implementation challenges [ 48 ] included the involvement and interest of local authorities, the need for a standard training module, unexpected delays when frontline health professionals dropped out after training, inability to attend when male members of the family were not present, social stigmas, insufficient time due to work commitments, misconception such as “tobacco gives relief from toothache,” self-management of oral lesions by taking “more lime” to regress, and poor lighting within homes for proper screening. Other reasons included poor compliance to recall due to unwillingness to travel the distance for a biopsy, unwillingness to biopsy due to fear of injections, blood, and formation of the wound.…”

“…Some studies did not calculate the intra-observer agreement between the community health workers in detecting normal and abnormal oral lesions and power calculation [ 35 , 42 , 48 ]. Most of the participants all belonged to the same geographic region, so this study's findings cannot be generalized.…”

Detecting salivary host-microbiome RNA signature for aiding diagnosis of oral and throat cancer

“…In addition, there is significant upskilling required for thorough examination and the results might be operator dependent. Another example is the Oncogrid surveillance program [36] which uses mobile phones connecting primary care dental practitioners and frontline health workers with oral cancer specialists for screening oral cancer. While these methods are easily accessible, they may only be partially useful for certain low resource setting areas, as they have low sensitivity (around 70%-85%) due to the limitations of the access to certain areas of the mouth cavity [37] [38].…”

Economic Evaluation of Oral Cancer Screening Programs: Review of Outcomes and Study Designs

“…The following supporting information can be downloaded at: , Table S1: Search term examples; Table S2: Excluded full-text articles; Table S3: Quality Assessment using the Quality of Health Economic Studies (QHES) Instrument; Table S4: The Philips Checklist for model-based economic evaluations. References [ 7 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ] are cited in the supplementary materials.…”