Training Primary Care Workers towards mHealth Technology to Enable Remote Diagnosis of Oral Cancer in Rural South India: Exploratory Study

  • Samuel SR, Al Moutassem Billah Khair, Abed Elkaseh, Gulrez Nadeem, Issameldin Abdalla Elkhader, Sunaina Manipal, Awad Ashekhi


Oral cancer is endemic in India and primary care workers (PCW) are often first contact in rural India. PCW were trained in mobile intra-oral photography to screening oral pre-cancer, cancer lesions among individuals using tobacco. PCW with smart-phone (8-megapixels-camera, internet) clicked five photographs of lesions using cheek retraction, recorded patient demographics, habit history and uploaded in open-source app. Images were assessed by two remote diagnosticians (D1/D2); 139 patients were screened, and leukoplakia(23) was most common and carcinoma(2) the least. Among precancerous lesions, percent agreement for D1 was 89.6% (kappa=0.79) and D2 was 91.2% (kappa=0.81). Training PCW towards mHealth enabled early detection and prompt diagnosis of oral pre-cancer in rural areas, and can help reduce the overall burden of oral cancer in India.