Utilization of primary health care workers for early detection of oral cancer and precancer cases in Sri Lanka.

Oral cancer presents a serious public health problem in south-east Asian countries. In Sri Lanka and India 35-40% of all cancers are reported to be oral cancers, which are curable if detected in the early stages. The idea that, in developing countries, one of the few practical approaches to early detection of these cases could be through the utilization of primary health care workers was tested in a field study carried out in Sri Lanka. In a control area the subjects with oral lesions were identified by medical/dental officers. In the study, 34 primary health care workers were able, alongside their routine duties, to examine the oral cavity of 28 295 subjects during a period of 52 weeks; 1220 subjects were detected with lesions needing re-examination. The performance of these primary health care workers was very satisfactory in terms of the number of cases detected and the accuracy of their diagnoses, which were verified by re-examination at a specially designated referral centre. The clinical diagnoses of the three categories of lesions detected were as follows: stage 1 lesions for observation (homogeneous or ulcerated leukoplakia), stage 2 lesions for investigation (speckled leukoplakia, erythroplakia, or submucous fibrosis), and stage 3 lesions for treatment (cancer). There was 89% correspondence between the stage 1-3 diagnoses by the health workers and the clinical diagnoses made at the referral centre. However, compliance by patients was low because only 50% of the cases detected in the field attended the referral centre. The cost-effectiveness of this approach to cancer control has been demonstrated.