Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial
Oral cancer is common in men from developing countries, and is increased by tobacco and alcohol use. We aimed to assess the effect of visual screening on oral cancer mortality in a cluster-randomised controlled trial in India. Of the 13 clusters chosen for the study, seven were randomised to three r...
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| Veröffentlicht in: | The Lancet (British edition) 2005-06, Vol.365 (9475), p.1927-1933 |
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| container_issue | 9475 |
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| container_title | The Lancet (British edition) |
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| creator | Sankaranarayanan, Rengaswamy Ramadas, Kunnambath Thomas, Gigi Muwonge, Richard Thara, Somanathan Mathew, Babu Rajan, Balakrishnan |
| description | Oral cancer is common in men from developing countries, and is increased by tobacco and alcohol use. We aimed to assess the effect of visual screening on oral cancer mortality in a cluster-randomised controlled trial in India.
Of the 13 clusters chosen for the study, seven were randomised to three rounds of oral visual inspection by trained health workers at 3-year intervals and six to a control group during 1996–2004, in Trivandrum district, Kerala, India. Healthy participants aged 35 years and older were eligible for the study. Screen-positive people were referred for clinical examination by doctors, biopsy, and treatment. Outcome measures were survival, case fatality, and oral cancer mortality. Oral cancer mortality in the study groups was analysed and compared by use of cluster analysis. Analysis was by intention to treat.
Of the 96 517 eligible participants in the intervention group, 87 655 (91%) were screened at least once, 53 312 (55%) twice, and 29 102 (30%) three times. Of the 5145 individuals who screened positive, 3218 (63%) complied with referral. 95 356 eligible participants in the control group received standard care. 205 oral cancer cases and 77 oral cancer deaths were recorded in the intervention group compared with 158 cases and 87 deaths in the control group (mortality rate ratio 0·79 [95% CI 0·51–1·22]). 70 oral cancer deaths took place in users of tobacco or alcohol, or both, in the intervention group, compared with 85 in controls (0·66 [0·45–0·95]). The mortality rate ratio was 0·57 (0·35–0·93) in male tobacco or alcohol users and 0·78 (0·43–1·42) in female users.
Oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37 000 oral cancer deaths worldwide. |
| doi_str_mv | 10.1016/S0140-6736(05)66658-5 |
| format | Article |
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Of the 13 clusters chosen for the study, seven were randomised to three rounds of oral visual inspection by trained health workers at 3-year intervals and six to a control group during 1996–2004, in Trivandrum district, Kerala, India. Healthy participants aged 35 years and older were eligible for the study. Screen-positive people were referred for clinical examination by doctors, biopsy, and treatment. Outcome measures were survival, case fatality, and oral cancer mortality. Oral cancer mortality in the study groups was analysed and compared by use of cluster analysis. Analysis was by intention to treat.
Of the 96 517 eligible participants in the intervention group, 87 655 (91%) were screened at least once, 53 312 (55%) twice, and 29 102 (30%) three times. Of the 5145 individuals who screened positive, 3218 (63%) complied with referral. 95 356 eligible participants in the control group received standard care. 205 oral cancer cases and 77 oral cancer deaths were recorded in the intervention group compared with 158 cases and 87 deaths in the control group (mortality rate ratio 0·79 [95% CI 0·51–1·22]). 70 oral cancer deaths took place in users of tobacco or alcohol, or both, in the intervention group, compared with 85 in controls (0·66 [0·45–0·95]). The mortality rate ratio was 0·57 (0·35–0·93) in male tobacco or alcohol users and 0·78 (0·43–1·42) in female users.
Oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37 000 oral cancer deaths worldwide.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(05)66658-5</identifier><identifier>PMID: 15936419</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Alcohol Drinking ; Alcohol use ; Alcohols ; Areca ; Cancer ; Clinical outcomes ; Cluster Analysis ; Developing countries ; Female ; Humans ; India - epidemiology ; LDCs ; Male ; Mass Screening ; Mastication ; Medical personnel ; Medical screening ; Mortality ; Mouth Neoplasms - diagnosis ; Mouth Neoplasms - mortality ; Physical Examination ; Risk Factors ; Smoking ; Tobacco ; Tobacco smoke</subject><ispartof>The Lancet (British edition), 2005-06, Vol.365 (9475), p.1927-1933</ispartof><rights>2005 Elsevier Ltd</rights><rights>Copyright Lancet Ltd. Jun 4-Jun 10, 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-bd5688f96080a3ab753c80eefa31f84dc21eef3f3ac39c5cfd3038903c8d6c6b3</citedby><cites>FETCH-LOGICAL-c442t-bd5688f96080a3ab753c80eefa31f84dc21eef3f3ac39c5cfd3038903c8d6c6b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/199027834?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15936419$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sankaranarayanan, Rengaswamy</creatorcontrib><creatorcontrib>Ramadas, Kunnambath</creatorcontrib><creatorcontrib>Thomas, Gigi</creatorcontrib><creatorcontrib>Muwonge, Richard</creatorcontrib><creatorcontrib>Thara, Somanathan</creatorcontrib><creatorcontrib>Mathew, Babu</creatorcontrib><creatorcontrib>Rajan, Balakrishnan</creatorcontrib><creatorcontrib>for the Trivandrum Oral Cancer Screening Study Group</creatorcontrib><creatorcontrib>Trivandrum Oral Cancer Screening Study Group</creatorcontrib><title>Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Oral cancer is common in men from developing countries, and is increased by tobacco and alcohol use. We aimed to assess the effect of visual screening on oral cancer mortality in a cluster-randomised controlled trial in India.
Of the 13 clusters chosen for the study, seven were randomised to three rounds of oral visual inspection by trained health workers at 3-year intervals and six to a control group during 1996–2004, in Trivandrum district, Kerala, India. Healthy participants aged 35 years and older were eligible for the study. Screen-positive people were referred for clinical examination by doctors, biopsy, and treatment. Outcome measures were survival, case fatality, and oral cancer mortality. Oral cancer mortality in the study groups was analysed and compared by use of cluster analysis. Analysis was by intention to treat.
Of the 96 517 eligible participants in the intervention group, 87 655 (91%) were screened at least once, 53 312 (55%) twice, and 29 102 (30%) three times. Of the 5145 individuals who screened positive, 3218 (63%) complied with referral. 95 356 eligible participants in the control group received standard care. 205 oral cancer cases and 77 oral cancer deaths were recorded in the intervention group compared with 158 cases and 87 deaths in the control group (mortality rate ratio 0·79 [95% CI 0·51–1·22]). 70 oral cancer deaths took place in users of tobacco or alcohol, or both, in the intervention group, compared with 85 in controls (0·66 [0·45–0·95]). The mortality rate ratio was 0·57 (0·35–0·93) in male tobacco or alcohol users and 0·78 (0·43–1·42) in female users.
Oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37 000 oral cancer deaths worldwide.</description><subject>Adult</subject><subject>Alcohol Drinking</subject><subject>Alcohol use</subject><subject>Alcohols</subject><subject>Areca</subject><subject>Cancer</subject><subject>Clinical outcomes</subject><subject>Cluster Analysis</subject><subject>Developing countries</subject><subject>Female</subject><subject>Humans</subject><subject>India - epidemiology</subject><subject>LDCs</subject><subject>Male</subject><subject>Mass Screening</subject><subject>Mastication</subject><subject>Medical personnel</subject><subject>Medical screening</subject><subject>Mortality</subject><subject>Mouth Neoplasms - diagnosis</subject><subject>Mouth Neoplasms - mortality</subject><subject>Physical Examination</subject><subject>Risk Factors</subject><subject>Smoking</subject><subject>Tobacco</subject><subject>Tobacco 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Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sankaranarayanan, Rengaswamy</au><au>Ramadas, Kunnambath</au><au>Thomas, Gigi</au><au>Muwonge, Richard</au><au>Thara, Somanathan</au><au>Mathew, Babu</au><au>Rajan, Balakrishnan</au><aucorp>for the Trivandrum Oral Cancer Screening Study Group</aucorp><aucorp>Trivandrum Oral Cancer Screening Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2005-06-04</date><risdate>2005</risdate><volume>365</volume><issue>9475</issue><spage>1927</spage><epage>1933</epage><pages>1927-1933</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Oral cancer is common in men from developing countries, and is increased by tobacco and alcohol use. We aimed to assess the effect of visual screening on oral cancer mortality in a cluster-randomised controlled trial in India.
Of the 13 clusters chosen for the study, seven were randomised to three rounds of oral visual inspection by trained health workers at 3-year intervals and six to a control group during 1996–2004, in Trivandrum district, Kerala, India. Healthy participants aged 35 years and older were eligible for the study. Screen-positive people were referred for clinical examination by doctors, biopsy, and treatment. Outcome measures were survival, case fatality, and oral cancer mortality. Oral cancer mortality in the study groups was analysed and compared by use of cluster analysis. Analysis was by intention to treat.
Of the 96 517 eligible participants in the intervention group, 87 655 (91%) were screened at least once, 53 312 (55%) twice, and 29 102 (30%) three times. Of the 5145 individuals who screened positive, 3218 (63%) complied with referral. 95 356 eligible participants in the control group received standard care. 205 oral cancer cases and 77 oral cancer deaths were recorded in the intervention group compared with 158 cases and 87 deaths in the control group (mortality rate ratio 0·79 [95% CI 0·51–1·22]). 70 oral cancer deaths took place in users of tobacco or alcohol, or both, in the intervention group, compared with 85 in controls (0·66 [0·45–0·95]). The mortality rate ratio was 0·57 (0·35–0·93) in male tobacco or alcohol users and 0·78 (0·43–1·42) in female users.
Oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37 000 oral cancer deaths worldwide.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>15936419</pmid><doi>10.1016/S0140-6736(05)66658-5</doi><tpages>7</tpages></addata></record> |
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| ispartof | The Lancet (British edition), 2005-06, Vol.365 (9475), p.1927-1933 |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Business Source Complete; ProQuest Central UK/Ireland |
| subjects | Adult Alcohol Drinking Alcohol use Alcohols Areca Cancer Clinical outcomes Cluster Analysis Developing countries Female Humans India - epidemiology LDCs Male Mass Screening Mastication Medical personnel Medical screening Mortality Mouth Neoplasms - diagnosis Mouth Neoplasms - mortality Physical Examination Risk Factors Smoking Tobacco Tobacco smoke |
| title | Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial |
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