Oral Potentially Malignant Disorders in high-risk groups in South Asia: A novel approach to screening and the way forward

Background: Oral cancer is a growing cause of concern, particularly in low- and middle-income countries (LMICs) where the burden is rising due to the continuous use of smokeless tobacco (ST) as well as due to poor access to healthcare for timely detection and management. Aim: To investigate the causal link between ST and cancer, develop and adapt screening guidelines for Oral Potentially Malignant Disorders (OPMD) and oral cancer and training toolkit for Community Health Workers (CHWs), and evaluate its feasibility and acceptability among CHWs. Methods: The research comprised 3 studies. Study 1 was a systematic review for assessing the carcinogenic potential of ST. Study 2 proposed a practical solution to tackle ST-related oral cancer in South Asia, involving the adaptation of oral cancer screening guidelines and a training toolkit for CHWs. Study 3 assessed the feasibility and acceptability of remotely training CHWs to screen OPMDs and oral cancer using a pre-post survey and in-depth interviews. Results: The systematic review found that the level of carcinogens in ST varied widely across the globe, with the highest being in South Asia. Using the ADAPTE framework, oral cancer screening guidelines were contextually adapted and a toolkit was developed for CHWs engaging experts and stakeholders. Participants recruited from India and Bangladesh were trained remotely. The adapted guidelines and training were found feasible and acceptable by CHWs. The training helped CHWs in acquiring the required competencies and enhanced their capability in screening for OPMD and oral cancer. Conclusion: ST products, particularly those used in LMICs, are highly carcinogenic and the key reason for the rising oral cancer burden in South Asia. Contextually adapted guidelines and training can enable non-specialist CHWs to screen for OPMD and oral cancer. If scaled up, trained CHWs can play an important role in preventing oral cancer