Effectiveness of oral cancer training programs for frontline health workers: A systematic review and meta-Analysis

Oral cancer represents a significant public health burden globally, with multiple challenges to its effective control particularly in developing economies. Despite established risk factors, early detection remains suboptimal, resulting in poor prognosis and increased mortality. This review aimed to systematically synthesize evidence on the effectiveness of training programs for frontline health workers in improving oral cancer screening outcomes.

A comprehensive search was conducted in PubMed, Google scholar, Scopus, Cochrane by two independent investigators using defined eligibility criteria. Data were extracted using a standardized form, and study quality was assessed using the Newcastle-Ottawa Scale, Joanna Briggs Institute tool, and Cochrane Risk of Bias 2.0. Primary outcomes were post-training change in knowledge, sensitivity and specificity of examinations, predictive values, and establishment of referral pathways. Data synthesis included qualitative analysis and random-effects meta-analysis where possible. PRISMA guidelines were followed.

The search resulted in identification of 32,212 records out of which fifteen articles were included for qualitative synthesis. The meta-analysis indicated an improvement in knowledge scores among frontline health workers following the training program; however, the effect was not statistically significant (SMD -2.81; 95% CI (-5.98 to 0.35), with substantial heterogeneity across studies (I² = 98%). Diagnostic accuracy of oral visual examination demonstrated a sensitivity of 74% and a specificity of 94%, suggesting good discriminatory ability; however, considerable heterogeneity across studies warrants cautious interpretation.

This review provides evidence that strengthening primary health care capacity through training of frontline health workers is essential for the early detection and prevention of oral cancer. Such efforts are critical to reducing the burden of oral cancer, particularly in high-risk populations.