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

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.