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

This study assessed the feasibility and effectiveness of training community health workers (CHWs) to detect oral cancer using a mobile phone–based screening approach in a resource-limited setting in India. Conducted between January 2020 and March 2021 in Gautam Budh Nagar district, the study addressed the critical challenge of limited specialist availability for early detection of oral cancer, particularly among underserved populations.

A total of 1,200 individuals aged 30 years and above, as well as younger individuals with a history of tobacco use, were screened during home visits by trained CHWs. Screening was performed using a mobile application to capture standardized oral images and relevant clinical findings. Subsequently, 1,018 participants underwent independent clinical examination by trained dentists, enabling a direct comparison of diagnostic performance between CHWs and specialists.

The findings demonstrated a very high level of agreement between CHWs and dentists, with a kappa value of 0.90, indicating near-perfect concordance. The sensitivity and specificity of CHW-led screening were 96.69% and 98.69%, respectively, underscoring the high reliability of this task-shifting approach. These results confirm that, following structured training and ongoing supervision, CHWs can accurately identify suspicious oral lesions and appropriately refer individuals for further diagnostic evaluation.

Overall, the study provides robust evidence that integrating CHWs into oral cancer screening programs using mobile health technology is both feasible and effective. This model represents a scalable and cost-effective strategy to enhance early detection of oral cancer, particularly in resource-constrained settings with limited specialist access, and supports its potential integration into existing public health systems.