Evaluation of the utilization of primary healthcare staff for control of oral cancer: A Sri Lankan experience

Background: Population-based screening programmes utilizing primary healthcare (PHC) staff have been undertaken in several countries with high incidence of oral cancer and oral potentially malignant disorders (OPMDs). Objective: The main objective of this study is to re-evaluate the utilization of PHC staff for the detection of OPMD and the early detection of oral cancer. Methods: A cross-sectional community-based study was done in the Sabaragamuwa province in Sri Lanka by conducting interview and oral examination on 1029 subjects aged 30 years or more, over a 1 year period from November 2006. The study protocol included an interviewer-administered questionnaire to gather sociodemographic factors and lifestyle habits. A 2-day training programme involving didactic sessions followed by practical field training was held for all local PHC staff (n = 67). Subjects screened by PHC staff were re-examined by the principal investigator (PI) to assess the validity of the screening. Results: A total of 685 subjects were screened by both PHC staff and the PI. In terms of the detection of any abnormality, sensitivity of the screening by PHC workers was 63%, with a specificity of 82.6%, a positive predictive value (PPV) of 24.8% and negative predictive value of 96.1%. Of the various OPMDs, poor agreement was noted in the detection of early oral submucous fibrosis. Among intra-oral sites missed by PHC staff, surprisingly high numbers were in the buccal mucosa and commissures. Conclusion: Low sensitivity and PPV in the present study indicate the necessity for improved training and facilities for better visualization of all intra-oral sites and/or an entirely different approach. An alternative strategy based on determining risk factors in the lives of individuals, with referral to local government dental clinics, could be a better option for screening for early detection of oral cancer in the South Asian scenario.