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)

“Vaai Ganam” - a screening program for early detection of oral potentially malignant disorders and oral cancer among truck drivers in Chennai – a cross-sectional survey

“…of its gross domestic product. 13 The Indian 16 The study conducted by D'Cruzet et al used exfoliative cytology using the oral rub and rinse technique, which had considerably lesser sensitivity values. 17 Despite these contrasting results, several Cochrane reviews 18 and Indian studies 19 have endorsed the advantages of opportunistic oral screening using visual and tactile examinations for high-risk tobacco and alcohol users for early case detection.…”

Clinical and histopathological correlation of oral malignancy and potentially malignant disorders based on a screening program at high-risk population in Tamil Nadu, India

“…The screening program results have already been presented in an earlier publication by the authors (10). In this screening program, 77 biopsies were taken from subjects, among whom 74 were histologically examined.…”

“…This correlation based on the sensitivity and specificity of chair-side diagnosis becomes important to help standardize the diagnostic technique used for screening, leading to uniform reporting and appropriate use of limited resources. The study had various primary objectives which have been analyzed and published in the past, this paper was taken up with the intention to analyze and discuss the sensitivity and specificity of the visual oral screening when compared to the histological findings, which were considered the "gold standard" (10).…”

A Systematic Review On The Prevalence Of Oral Cancer Among Tobacco And Non-Tobacco Users In Tamil Nadu

“…The subject with definite malignancy was seen in the group with tobacco usage, and it has found to be statistically significant (p<0.014). 11 The study conducted by Geeta Sharma et al, in the year 2020, conducted research among 5240 participants of age group 18-60 in Tamil Nadu, and they were divided into groups based on their tobacco usage. The prevalence of oral cancer is seen to be higher than the evaluated value in this study (p<0.72).…”