Feasibility of Training Community Health Workers in the Detection of Oral Cancer

IMPORTANCE: Visual screening for oral cancer has been found to be useful in a large randomized clinical trial in Kerala, India, showing substantial reduction in mortality. To address the shortage of medical personnel in resource-deficient regions, using the services of community health workers has been proposed as a strategy to fill the gap in human resources in health care. OBJECTIVE: To assess the feasibility of community health workers in screening and early detection of oral cancer using a mobile application capturing system. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study using a household sample was conducted in 10 areas of Gautam Budhnagar district, Uttar Pradesh, India, from January 31, 2020, to March 31, 2021, to assess the feasibility of identification of oral lesions by community health workers using a mobile phone application compared with diagnosis by trained dentists in a screening clinic. Men and women aged 30 years or older as well as tobacco users younger than 30 years were eligible for screening. INTERVENTIONS: Screening by trained community health workers vs dentists. RESULTS: A total of 1200 participants were screened by the community health workers during their home visits; of these, 1018 participants (526 [51.7%] men; mean [SD] age, 35 [16] years) were also referred and screened by the dentists a clinic. There was near-perfect agreement (κ = 0.9) between the findings of the community health workers and the dentists in identifying the positive or negative cases with overall sensitivity of 96.69% (95% CI, 94.15%-98.33%) and specificity of identification of 98.69% (95% CI, 97.52%-99.40%). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, trained community health workers were able after initial supervision by qualified dentists to perform oral cancer screening programs. These findings suggest that community health workers can perform this screening in resource-constrained settings.