Opportunistic Screening of Oral Potentially Malignant Disorders: A Public Health Need for India

Abstract

PURPOSE Oral cancer (OC) is the leading cancer in 25% of Indian cancer registries, and 80% of OCs are diagnosed in advanced stages. OC screening is a topic of debate. Studies from other countries have used a variety of study designs as OC screening strategies. There are not many studies from India on strategic screening, and there is a need to review the literature to provide insights and knowledge about screening programs. The purpose of this narrative review is to present broad epidemiologic evidence on the OC burden in India, to discuss and summarize the currently available evidence for OC screening strategies, and to highlight a feasible opportunistic screening strategy for addressing OC burden in India. METHODS Medline and EMBASE were used to identify articles. Data from GLOBOCAN and government reports were obtained from websites. As many key concepts and divergent views cannot be addressed with a single research question, a narrative review was considered appropriate, but to ensure a comprehensive literature search, a systematic review search strategy was used. RESULTS OC rates are rising more rapidly in India than projected. Wide variations in OC incidence within India reflect regional diversity of risk factors. Studies abroad have demonstrated the feasibility of opportunistic screening of oral potentially malignant disorders by dentists; however, although recommendations exist in India, no studies of opportunistic screening by dentists have been reported. CONCLUSION The projected major increases in the OC burden necessitate an OC screening program; opportunistic screening of high-risk groups by dentists using oral visual examination is recommended as a cost-effective strategy. As a way forward, a pilot project to assess the feasibility of regional opportunistic screening is in progress.

Smokeless tobacco use and oral potentially malignant disorders among people living with HIV (PLHIV) in Pune, India: Implications for oral cancer screening in PLHIV

“…We hypothesize that this observation is driven by survival bias. As mentioned earlier, the estimated average time to malignant transformation of OPMDs is 4–10 years [ 8 , 9 ]. The paucity of HIV-specific data makes it difficult to surmise if average time would be significantly different in PLHIV.…”

“…The ease of access of the oral cavity without privacy requirements, makes OPMDs readily amenable to detection even in resource limited settings [ 7 ]. Moreover, as the estimated average time to malignant transformation is 4–10 years, OPMDs present an important phase of opportunity to introduce interventions that disrupt the natural history of oral cancer [ 8 , 9 ]. Prevalence estimates of OPMDs for Indian HIV uninfected individuals are among the highest in the world [ 9 , 10 ].…”

The 4P: Preventing Preneoplasia through Patients Partnership

“…In this type of screening, it is important to take into account geographic gaps in the availability of cancer diagnostic [20]. Some developed countries already follow this screening routine for populations over 30 years of age that have a risk of developing oral cancers, but for example, in Southeast Asian countries, the resources of all countries do not necessarily allow this visual oral screening even if it is a national priority [21,22]. Europe involvement in the detection of these diseases must be concretized by a systematic examination of the oral cavity.…”

A compendium of population wide DNA methylation profile for oral cancer in India

“…India has one-third of oral cancer cases of the world and therefore has long been regarded as an epicenter of oral cancer. [3] It accounts for around 30% of all cancers primarily related to tobacco as reported by the Indian Council of Medical Research. According to GLOBOCAN 2018, new cases of oral cancer in India is estimated to rise from 1.15 million in 2018 to 1.9 million by 2040 and oral cancer deaths is estimated to rise from 0.78 million to 1.33 million by 2040.…”