Challenges in global improvement of oral cancer outcomes: findings from rural Northern India

Setting: Community-based cross sectional OC screening.Participants: With help from the Department of Health (DOH), Haryana and the local communities, we visited three villages and recruited 761 participants of ages 45-95 years. Participants received a visual oral cancer examination and were interviewed about their dental/medical history and personal habits. Pregnant women, children and males/females below 45 years old with history of OC were excluded.Main outcome: Presence of a suspicious oral lesion.Out of 761 participants, 42 (5.5%) were referred to a local dentist for follow-up of suspicious lesions. Males were referred more than females. The referral group had more bidi and hookah smokers than non smokers as compared to non referral group. The logistic regression analysis revealed that smoking bidi and hookah (OR = 3.06 and 4.42) were statistically significant predictors for suspicious lesions.Tobacco use of various forms in rural, northern India was found to be quite high and a main risk factor for suspicious lesions. The influence of both the DOH and community participation was crucial in motivating people to seek care for OC.While many oral health prevention measures have been adopted worldwide, their implementation is largely unknown in small and rural areas of developing countries. There is also little known as how one can prevent the occurrence of oral cancer (OC) in geographic areas with high risk factors that are unique to the developing world and in an environment of low literacy and fragmented health systems. For example, in rural India having 80% of elderly population [1], smokeless tobacco use is high, knowledge about health is low, and access to health care is a challenge.India has one of the highest rates of OC in the world, accounting for one-third of the total cancer burden; this figure continues to rise and accounts for 50-70% of total cancer mortality [2]. Many epidemiological studies conducted over the last three decades in America, Europe and