Pilot Model for Community Based Oral Cancer Screening Program: Outcome from 4 Northeastern Provinces in Thailand

Abstract

Management of advanced-stage oral cancer adds a great burden to individuals and health care systems. Community-based oral cancer screening can be beneficial in early detection and treatment. In this study, a novel oral cancer screening program was conducted utilizing an existing network of health care personnel, facilities, and digital database management for efficient coverage of a large population. The screening program considered 392,396 individuals aged ≥40 from four northeastern provinces in Thailand. Three levels of screening were performed: S1 by village healthcare volunteers to identify risk groups, S2 by dental auxiliaries to visually identify abnormal oral lesions, and S3 by dentists for final diagnosis and management. A total of 349,318 individuals were interviewed for S1, and 192,688 were identified as a risk group. For S2, 88,201 individuals appeared, and 2969 were further referred. Out of 1779 individuals who appeared for S3, oral potentially malignant disorders (OPMDs) were identified in 544, non-OPMDs in 1047, doubtful lesions in 52, and no results in 136 individuals. Final treatment was carried out in 704 individuals that included biopsies of 504 lesions, exhibiting 25 cancerous lesions and 298 OPMDs. This study is so far one of the largest oral cancer screening programs conducted in Thailand and showed effective implementation of community-based oral cancer screening.

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

“…Of the 16 studies (Table 1), 15 were conducted in Asia, including 4 each in Taiwan, India, and China and 1 each in Singapore, Japan, and Thailand . The only study performed outside Asia was from Portugal.…”

“…Five studies were community-based clustered randomized clinical trials (RCTs), including 3 studies reporting data from a 15-year RCT in Kerela, India, and 2 studies showing the preliminary and interim results from a 5-year RCT in southern China. The remainder were observational studies, including 5 cohort studies, 3 case series, and 3 cross-sectional studies . A control group was assessed in 10 studies .…”

“…Critical appraisal of the methodologic quality revealed that all studies had either medium (n = 6) or low (n = 10) risk of bias. Large numbers of participants dropping out (n = 4), failure to control for confounders (n = 4), and inadequate blinding of outcome assessors (in RCTs, n = 5) led to potentially reduced quality of evidence in these studies (eTable in the Supplement).…”

“…All 11 OC studies described an oral inspection performed once or repeatedly every 2 to 3 years (Table 2); 6 studies exclusively examined targeted screening for high-risk adults, 4 studies assessed universal screening, and 2 studies presented both screening strategies. The most commonly applied method to identify high-risk adults was using individuals’ self-reported smoking, betel quid or tobacco chewing, or alcohol consumption status .…”

Diagnostic Accuracy of Screening of Lip and Oral Cavity Cancers or Potentially Malignant Disorders (PMD) by Frontline Workers: A Systematic Review and Meta-Analysis

“…It was demonstrated that screening with COE in individuals with highrisk behaviour (tobacco and/or alcohol users) leads to a significant reduction in oral cancer incidence and mortality in the long run (Sankaranarayanan et al, 2005). In the community based oral cancer screening program conducted in Thailand, 88,201 individuals were screened by dental auxiliaries and 544 oral potentially malignant disorders (OPMDs) and 1,047 non-OPMDs were identified by the dentists (Klongnoi et al, 2021). A district-level oral cancer screening program conducted at 48 panchayats of Kannur district in Kerala, India, proved that trained FHW could be effectively used in oral cancer screening programs agreeing with our review (Philip et al, 2018).…”