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The Indian Government is launching quinquennial oral cancer screening for all individuals aged 30+ years. Such screening would target approximately 584 million individuals, an endeavor with significant resource implications. We evaluate proof-of-principle for resource-efficient risk-based screening through reanalysis of the Kerala Oral Cancer Screening Trial.
We developed a risk prediction model for oral cancer incidence. Using this risk model to adjust for the risk factor imbalance between arms, through intention-to-treat analyses that accounted for cluster-randomization, we calculated the relative and absolute screening efficacy on oral cancer mortality. We used an inverted Lorenz curve to compare age-based versus risk-based eligibility strategies. Screening efficiency was compared across varying risk-eligibility thresholds.
Our study demonstrates that oral cancer screening through visual inspection by trained health workers is efficacious in reducing oral cancer mortality. Risk-based oral cancer screening strategies could substantially enhance the efficiency of screening programs, while maintaining high program-sensitivity.
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