Smokeless Tobacco-associated Lesions: A Mobile Health Approach

Area of Science:

• Oncology
• Public Health
• Digital Health

Background:

• India has the highest global incidence of oral cancer, with survival rates significantly lower than in developed nations.
• Late patient presentation is a primary driver of poor oral cancer outcomes in India.
• Early-stage screening and diagnosis are crucial for downstaging oral cancer and improving survival rates.

Purpose of the Study:

• To evaluate a pragmatic mobile health (mHealth) approach for oral cancer screening in a resource-constrained setting.
• To empower frontline health workers with mobile technology for early detection of oral lesions.
• To assess the utility of remote diagnosis by oral medicine specialists.

Main Methods:

• A cohort of 1,357 factory employees with a predominant pure tobacco chewing habit was screened in two phases.
• Phase I involved identifying and photographing oral lesions and habits, followed by remote specialist diagnosis.
• Phase II included cytology and biopsy for subjects identified as requiring further examination.

Main Results:

• Smokeless tobacco (SLT) was the predominant habit (582 subjects).
• Tobacco pouch keratosis was the most frequent lesion (397 subjects).
• Biopsies (71 subjects) revealed mostly hyperkeratosis and mild dysplasia, with one case of moderate dysplasia.

Conclusions:

• The mHealth approach effectively empowered healthcare workers to identify oral lesions and facilitated remote specialist diagnosis.
• The study demonstrated a low-risk profile for oral tissue alterations in the screened cohort.
• Electronic records were established for future cohort follow-up, highlighting the long-term utility of mHealth in cancer surveillance.