Abstract 5774: Indo-Canadian parternship for oral cancer screening in rural India
Authors: Datta Madhurima , Chaitanya Nallan CSK , Ndvn Shyam , Palat Gayatri , Jacob Jean , Chandran Priya , Rapelli Vineela , Jn Jagannath , Broughton Sandra , Sutcliffe Simon , Laronde Denise Marie 
Published: September 2020

Abstract
Aims: Oral cancer is ranked among the top three commonly occurring cancers in India with over 120,000 cases reported annually. Advanced stage diagnosis is common due to poor access to healthcare and low socioeconomic status, limiting the 5-year survival rate to a dismal 27%. In India, 60-80% of patients present with advanced disease as compared to 40% in developed countries. Oral cancer screening is a quick, painless, and non-invasive exam to detect suspicious lesions that can reduce mortality rates significantly. The aim of the project was to determine the feasibility of conducting oral cancer screening in rural areas around Hyderabad, India in collaboration with Two Worlds Cancer Collaboration, Canada; MNJ Cancer Hospital, India and two dental colleges in Hyderabad.
Methods: Planning and communication between the Indian and Canadian partners were facilitated by Zoom videoconferencing. Ethics approval for the feasibility phase was obtained in both countries. A feasibility study was planned in a rural village. Prior to screening, the Urulla village community school required infrastructure changes such as furniture and electricity. Fluorescence Visualization (FV) units were shipped from Canada to India to assess if they improve the sensitivity and specificity of screening in this setting. The Canadian team trained the Indian clinicians on use of FV and study methodology. The feasibility study was conducted in March 2018 where participants received a detailed risk habit evaluation, intraoral and extraoral examination.
Results: A total of 114 participants were screened, 62% males and 38% females with a median age of 55 years. Four percent had a family history of oral cancer, 33% had a smoking history of which the majority (65%) smoked beedis. Nineteen percent chewed pan, gutka or other chewing substances. Seventy-one percent drank alcohol, primarily beer/toddy (65%). Screening data was complete for 112 participants of which 16 (14.2%) had intraoral lesions. Lesion presence was not significantly associated with smoking, chewing habit or alcohol drinking (P=0.370, P=0.207, P=0.393). The majority of lesions were on the labial and buccal mucosa (79%). Forty-three percent of lesions showed a loss of fluorescence. Out of the 16 lesions, 7 lesions were clinically deemed as high-risk and recommended to undergo biopsy. Loss of fluorescence was noted in 6 out of 7 lesions, and was highly significant with high-risk lesion presence (p&lt;0.05) A total of 5 biopsies were carried out on the field which came back later as 1 carcinoma in situ, 1 low-grade dysplasia and 3 hyperkeratosis.
Conclusion: The high evidence of disease warrants the need for oral cancer screening in rural India. The feasibility study paved way for the pilot study which aims to screen over 1000 participantsin rural areas around Hyderabad using additional adjunct tools like FV and Quantitative Cytology to improve accuracy and semi-automate the screening process.
Acknowledgements: This study was supported through fundraising efforts by Two Worlds Cancer Collaboration, an NPO based in Kelowna, Canada. Two Worlds aims to provide cancer palliative care in low resource countries.
Citation Format: Madhurima Datta, Nallan CSK Chaitanya, Shyam Ndvn, Gayatri Palat, Jean Jacob, Priya Chandran, Vineela Rapelli, Jagannath Jn, Sandra Broughton, Simon Sutcliffe, Denise Marie Laronde. Indo-Canadian parternship for oral cancer screening in rural India [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5774.