Detection of oral cancer using basic health workers in an area of high oral cancer incidence in India.

In the rural health care delivery system in India, basic health workers (BHW) go house-to-house to help in the preventive and therapeutic measures of certain diseases. Some 53 BHW were trained by the dentists of the research team for examining the oral cavity of high-risk individuals and categorizing them into normals or those with referable or nonreferable lesions. Referable lesions comprised nodular leukoplakia, submucous fibrosis, and ulcers and growths suggestive of oral cancer. In a 1-year period, 39,331 high-risk individuals were examined by BHW and 523 (1.3%) were referred for further diagnosis. Some 72% arrived at the referral center and 20 oral cancers were confirmed among these individuals. Reexamination in the field by the dentists was conducted for 5% of the sample to obtain sensitivity and specificity estimates of BHW diagnosis. The findings indicate that incorporation of an oral cancer detection program in the existing health care infrastructure is feasible and beneficial.