Reproducibility of an oral cancer and precancer detection program using a primary health care model in Sri Lanka

A pilot feasibility study utilizing primary health care workers (PHCW) in the early detection of oral cancer and precancer was reported in 1984. The present study was to assess the reproducibility of this model in a different geographic area using existing Government Health Services. In order to improve the compliance of individual referrals following detection (54% in the previous study) a simultaneous health education program was mounted. Of 72,867 villagers aged 20 years and over who were allocated for screening, 57,124 (78%) were examined during 1 year by 36 PHCWs. Oral lesions were detected in 3559 (6.2%). Of these, 2193 (62%) complied by presenting for a reexamination at the hospital. Twenty new cancers and 1716 subjects with oral precancerous lesions were confirmed. While the population screening coverage achieved was higher than in the feasibility study, compliance was marginally improved. Noteworthy, however, was the detection of 20 new cancers as compared to 4 in the feasibility study. This primary health care model for cancer detection appears to be organizationally feasible for a developing country.