Reproducibility and validity of oral visual inspection by trained health workers in the detection of oral precancer and cancer

Abstract

Summary A randomized intervention trial is in progress in Kerala, India, to evaluate the effectiveness of oral visual inspection by trained health workers (HWs) in the prevention of oral cancer. Fourteen health workers with college graduation as the basic qualification were trained in oral visual inspection to identify oral cancers and precancers among the participants of the screening trial and to refer them for further confirmation and management. The aim of the present study was to evaluate the reproducibility and validity of the screening test provided by the health worker against the reference oral visual findings of three physicians. A total of 2069 subjects who had already been examined were re-examined by the health workers and physicians. The sensitivity and the specificity of the oral visual inspection were 94.3% and 99.3% respectively. There was moderate agreement between the findings of the initial and the repeat mouth examinations carried out by the health workers, which were on average 6 months apart. There was almost perfect agreement (kappa = 0.85) between the findings of the health workers and the physicians in identifying the different types of oral precancerous lesions. The findings of our study indicate that it is possible to train resource persons to perform the oral cancer screening test as accurately as doctors, although experience appears to be a crucial component of health workers' accuracy. The efficacy of such an approach to reduce the incidence of and mortality from oral cancer, however, remains to be proven.

Meta-analysis of measures of performance reported in oral cancer and precancer screening studies

“…[8][9][10][11][12][13][14] The studies and the basic information they yielded are listed in Table 2. Two of these, and the further reports listed in Table 3, provided outcome data on patients referred for secondary care including numbers of individuals screened, numbers referred, numbers who attended, true-and falsepositive rates, and positive predictive values of the test.…”

Opportunistic screening for oral cancer and precancer in general dental practice: results of a demonstration study

“…The setting of these studies varies, but overall, most show a prevalence of between 1 and 6%, which is similar to that found in this study and our other UK studies. 14,15 Most studies are of specific age groups, but those which show a high prevalence have usually been conducted in high risk groups and have been carried out with some element of targeting, either in countries where the prevalence of oral cancer and precancer is high, 28,30,31,33,40 in high-risk populations such as heavy smokers and drinkers or betel quid users, 24,36,42,47 as part of multiphasic screening such as those attending lung cancer clinics 46 or in convenience populations like the institutionalised elderly, forces personnel and attenders of hospital outpatients clinics or medical practices. 14,15,32,39 An informative UK study was that carried out by Pearson et al 47 among the Bangladeshi population of East London.…”

An integrated Approach to Worksite Tobacco Use Prevention and Oral Cancer Screening Among Factory Workers in Mumbai, india

“…Visual examination of the oral cavity is a simple approach used to detect asymptomatic oral cancers and precancerous lesions. The performance characteristics of this test are satisfactory in terms of sensitivity, specificity, and predictive value (Warnakulasuriya et al, 1984(Warnakulasuriya et al, :1991Mehta et al, 1986;Mathew et al, 1997), therefore, it is considered as a suitable screening test for oral cancer. Oral visual inspection of eligible subjects was performed with the help of a halogen flashlight by medical officer.…”