UTILIZATION OF PRIMARY HEALTH-CARE WORKERS FOR EARLY DETECTION OF ORAL-CANCER AND PRECANCER CASES IN SRI-LANKA

  • 1 January 1984
    • journal article
    • research article
    • Vol. 62  (2) , 243-250
Abstract
Oral cancer presents a serious public health problem in southeastern Asian countries. In Sri Lanka and India 35-40% of all cancers are reported to be oral cancers, which are curable if detected in the early stages. The idea that, in developing countries, 1 of the few practical approaches to early detection of these cases could be through the utilization of primary health care workers was tested in a field study carried out in Sri Lanka. In a control area, the subjects with oral lesions were identified by medical/dental officers. In the study, 34 primary health care workers were able, alongside their routine duties, to examine the oral cavity of 28,295 subjects during a period of 52 wk; 1220 subjects were detected with lesions needling re-examination. The performance of these primary health care workers was very satisfactory in terms of the number of cases detected and the accuracy of their diagnoses, which were verified by re-examination at a specially designated referral center. The clinical diagnoses of the 3 categories of lesions detected were as follows: stage 1 lesions for observation (homogeneous or ulcerated leukoplakia), stage 2 lesions for investigation (speckled leukoplakia, erythroplakia, or submucous fibrosis), and stage 3 lesions for treatment (cancer). There was 89% correspondence between the stage 1-3 diagnoses by the health workers and the clinical diagnoses made at the referral center. Compliance by patients was low because only 50% of the cases detected in the field attended the referral center. The cost-effectiveness of this approach to cancer control has been demonstrated.