ABSTRACT
Background:
India continues to face the pressing problem of oral cancer, especially among the rural population, which has inadequate healthcare facilities. Like every other type of cancer, oral cancer can be treated successfully if diagnosed at an early stage. This study evaluates the effectiveness of a community-based oral cancer screening program employing portable fluorescence spectroscopy in rural Madhya Pradesh, India, with a focus on its feasibility and diagnostic accuracy in a resource-constrained setting.
Methods:
This cross-sectional study was conducted across 20 villages in rural Madhya Pradesh. Participants aged 30–65 years were recruited through community health camps and awareness campaigns, resulting in a total of 584 participants. Oral examinations were performed by trained healthcare workers, and any suspicious lesions were further evaluated using a portable fluorescence spectroscopy device. Histopathological diagnoses obtained through biopsies served as the gold standard for comparison.
Results:
The prevalence of oral potentially malignant disorders (OPMDs) was 12.8%, and the prevalence of oral cancer was 3.1%. Portable fluorescence spectroscopy demonstrated a sensitivity of 88.2% and specificity of 92.6% for detecting OPMDs. For oral cancer detection, the sensitivity was 90.0%, and the specificity was 94.1%. The positive predictive value was 78.9% for OPMDs and 82.4% for oral cancer, while the negative predictive value was 96.3% and 97.5%, respectively.
Conclusions:
This community-based oral cancer screening program using portable fluorescence spectroscopy proved to be a valuable tool for the early detection of oral cancer and OPMDs in a rural setting. The program has the potential to improve oral cancer management along with the device on account of its ease of use and portability, especially in low resource regions. In addition, the findings of this study suggest that such technologies can also be incorporated within existing community health initiatives, enhancing reach and facilitating timely treatment. Further research is warranted to assess the long-term impact of this screening program on oral cancer mortality and morbidity.
KEYWORDS: Community-based, early detection, fluorescence spectroscopy, India, oral cancer, portable technology, prevention, resource-limited settings, rural, screening
INTRODUCTION
According to various studies conducted, India holds the highest toll regarding oral cancer. Not only are the cases of oral cancer high in India, but so is the mortality rate. As a result, oral cancer has become a major issue in terms of public health in India.[1,2] Although the struggle regarding oral cancer is widespread, rural areas struggle the most as they do not have adequate medical facilities.[3] There are various medical procedures which can help improve the outcome including increasing survival rates, however, the quick identification of oral cancer or any oral disorder is crucial.[4]
Using portable fluorescence spectroscopy has allowed for a breakthrough when it comes to the screening of oral cancer. This technology uses tissue autofluorescence, where specific tissues have varying strengths when they are illuminated by specific wavelengths. When certain tissues are exposed, some tissues may always emit fluorescence while others would do so at varying levels – making it easier to detect certain characteristics of a tissue.[5,6] Enabling the device to detect cancerous tissues, as it examines the tissue that emits fluorescence as a spectrum and consequently allows for the identification of normal and carcinogenic cells.[5,6] Other studies have also proved previous studies where the efficacy of fluorescence spectroscopy was seen.[7,8]
However, its implementation and evaluation in community-based screening programs, particularly in rural areas of India, remain limited.
This study aimed to evaluate the effectiveness of a community-based oral cancer screening program using portable fluorescence spectroscopy in rural Madhya Pradesh, India.
MATERIALS AND METHODS
Study design and setting
This cross-sectional study was conducted from June 2023 to December 2023 in 20 villages within the Jhabua district of rural Madhya Pradesh, India. The study area was characterized by predominantly low socioeconomic status, limited healthcare infrastructure, and a high prevalence of tobacco use, a major risk factor for oral cancer.
Ethical considerations
Ethical approval was obtained from the Institutional Ethics Committee of People’s Dental Academy, Bhopal. Informed consent was obtained from all participants before enrollment in the study.
Participant recruitment
Participants aged 30-65 years were recruited through community health camps organized in collaboration with the District Health Office, Jhabua, and local non-governmental organizations (NGOs). Awareness campaigns, including health talks by healthcare professionals, distribution of pamphlets and posters in local languages, and engagement with community leaders, were conducted to promote participation.
Screening procedure
Trained healthcare workers, consisting of two dental professionals and four auxiliary health workers who underwent a two-day training program on oral cancer screening and the use of the fluorescence spectroscopy device, conducted the oral examinations. They used visual inspection with adequate lighting (headlamps with focused beams) and bimanual palpation to identify any suspicious lesions in the oral cavity. Any suspicious lesions identified during the examination were further evaluated using a portable fluorescence spectroscopy device (VELscope Vx, LED Dental Inc., White Rock, BC, Canada).
Fluorescence spectroscopy
The fluorescence spectroscopy device emitted a specific wavelength of blue light (400-460 nm) onto the oral mucosa. The device’s sensor captured the resulting fluorescence, and the software analyzed the emitted spectrum. Based on the spectral characteristics, the device provided a real-time assessment of the tissue, classifying it as “normal” (green light indication), “suspicious” (amber light indication), or “highly suspicious” (red light indication).
Histopathological confirmation
Participants with lesions classified as “suspicious” or “highly suspicious” by fluorescence spectroscopy were referred to the nearest district hospital (District Hospital, Jhabua) for biopsy and histopathological examination. This diagnosis served as the gold standard for determining the presence of OPMDs or oral cancer.
Data analysis
Data were analyzed using SPSS Statistics (version 28, IBM Corp., Armonk, NY, USA). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of fluorescence spectroscopy for detecting OPMDs and oral cancer were calculated using standard formulas.
RESULTS
Participant characteristics
A total of 584 participants were screened, with a mean age of 48.5 years (SD ± 10.2). The majority of participants were male (365, 62.3%), and the most common risk factors reported were tobacco chewing (267, 45.7%) and smoking (165, 28.4%). Other risk factors included alcohol consumption (82, 14.0%), poor oral hygiene (210, 35.9%), and a family history of oral cancer (35, 6.0%).
Prevalence of OPMDs and oral cancer
The overall prevalence of OPMDs was 12.8% (75/584), and the prevalence of oral cancer was 3.1% (18/584). The most common OPMDs identified were leukoplakia (39, 6.7%) and erythroplakia (20, 3.4%). Other OPMDs included oral submucous fibrosis (12, 2.1%) and lichen planus (8, 1.4%).
Diagnostic accuracy of fluorescence spectroscopy
Table 1 presents the diagnostic performance of fluorescence spectroscopy for detecting OPMDs. The sensitivity and specificity were 88.2% and 92.6%, respectively. The PPV and NPV were 78.9% and 96.3%, respectively.
Table 1.
Diagnostic performance of fluorescence spectroscopy for detecting OPMDs
| OPMD Present | OPMD Absent | |
|---|---|---|
| Test Positive | 66 | 38 |
| Test Negative | 9 | 461 |
| Sensitivity | 88.20% | |
| Specificity | 92.60% | |
| PPV | 78.90% | |
| NPV | 96.30% |
PPV=Positive predictive value, NPV=Negative predictive value
Table 2 shows the diagnostic performance of fluorescence spectroscopy for detecting oral cancer. The sensitivity and specificity were 90.0% and 94.1%, respectively. The PPV and NPV were 82.4% and 97.5%, respectively.
Table 2.
Diagnostic performance of fluorescence spectroscopy for detecting oral cancer
| Cancer Present | Cancer Absent | |
|---|---|---|
| Test Positive | 16 | 30 |
| Test Negative | 2 | 536 |
| Sensitivity | 90.00% | |
| Specificity | 94.10% | |
| PPV | 82.40% | |
| NPV | 97.50% |
PPV=Positive predictive value, NPV=Negative predictive value
Table 3 presents the distribution of histopathological diagnoses among participants with suspicious lesions detected by fluorescence spectroscopy.
Table 3.
Histopathological diagnoses of suspicious lesions
| Diagnosis | Number of cases |
|---|---|
| Oral Cancer | 18 |
| Leukoplakia | 39 |
| Erythroplakia | 20 |
| Oral Submucous Fibrosis | 12 |
| Lichen Planus | 8 |
| Other | 5 |
DISCUSSION
This community-based oral cancer screening program using portable fluorescence spectroscopy demonstrated promising results for the early detection of oral cancer and OPMDs in a rural setting in Madhya Pradesh, India. The high sensitivity (88.2% for OPMDs and 90.0% for oral cancer) and specificity (92.6% for OPMDs and 94.1% for oral cancer) observed in our study suggest that this technology can effectively identify individuals with suspicious lesions who require further diagnostic evaluation. A close relationship exists between these findings and a recent meta-analysis by Bansal et al.[9] pooled NPV to be 96.3% and 97.5% for OPMDs and oral cancer respectively. The finding high sensitivity 86% and specificity 83% of the method for OPMDs and oral cancer in that case. The high Negative Predictive Value NPV is important in this context for a screening program since it means that they will be able to test for disease free individuals, and, in so doing, potentially decrease the number of unnecessary consultations and biopsies.
Our findings compare favorably to previous studies evaluating fluorescence spectroscopy for oral cancer screening. A study by Farah et al.[10] in a primary care setting reported a sensitivity of 81% and specificity of 76% for detecting oral lesions. However, our study demonstrated higher sensitivity and specificity, likely due to the use of a more advanced fluorescence spectroscopy device and the training provided to the healthcare workers. While our study demonstrated the feasibility of integrating fluorescence spectroscopy into community-based programs, a limitation is the reliance on histopathological confirmation, which may not be readily available in all rural settings. Furthermore, the cross-sectional design limits our ability to assess the long-term impact of the screening program on oral cancer mortality and morbidity. An unexpected finding was the relatively high prevalence of oral submucous fibrosis (2.1%) in our study population, which warrants further investigation and targeted interventions.
Our results support the hypothesis that this approach can be used to screen oral cancer and OPMDs with reasonable accuracy in resource-limited settings. The relevance of this work is that it may help to lessen the burden of oral cancer and increase access to care in rural areas where this disease is prevalent.
CONCLUSION
This community-based oral cancer screening program using portable fluorescence makes it possible to detect cancer in the rural areas of Madhya Pradesh, India, using portable fluorescence. The attributes of having high sensitivity and specificity as well as simplicity of applying a handheld device will hopefully enhance oral cancer survival in rural areas. This can be enhanced by the installation of this technology to enhance the utilization of health programs within the community.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. doi: 10.3322/caac.21660. [DOI] [PubMed] [Google Scholar]
- 2.Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al. ICMR-NCDIR-NCRP Investigator Group. Cancer Statistics, 2020:Report From National Cancer Registry Programme, India. JCO Glob Oncol. 2020;6:1063–75. doi: 10.1200/GO.20.00122. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Kumar P, Rathod S. Integration of the fluorescence based portable device with the AI tools for the real-time monitoring of oral mucosal lesions. Sci Rep. 2025;15:10222. doi: 10.1038/s41598-025-94676-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India:A cluster-randomised controlled trial. Lancet. 2005;365:1927–33. doi: 10.1016/S0140-6736(05)66658-5. [DOI] [PubMed] [Google Scholar]
- 5.Kumar P, Rathod S, Pradhan A. Detection of oral mucosal lesions by the fluorescence spectroscopy and classification of cancerous stages by support vector machine. Lasers Med Sci. 2024;39:42. doi: 10.1007/s10103-024-03995-3. [DOI] [PubMed] [Google Scholar]
- 6.Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol. 2008;44:10–22. doi: 10.1016/j.oraloncology.2007.06.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Scully C, Bagan JV, Hopper C, Epstein JB. Oral cancer:current and future diagnostic techniques. Am J Dent. 2008;21:199–209. [PubMed] [Google Scholar]
- 8.Omar E. Current concepts and future of noninvasive procedures for diagnosing oral squamous cell carcinoma-A systematic review. Head Face Med. 2015;11:6. doi: 10.1186/s13005-015-0063-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Rocha MB, Pratavieira S, Vieira RS, Geller JD, Stein ALM, de Oliveira FSS, et al. Fluorescence images of skin lesions and automated diagnosis using convolutional neural networks. Photodiagnosis Photodyn Ther. 2025;52:104462. doi: 10.1016/j.pdpdt.2024.104462. [DOI] [PubMed] [Google Scholar]
- 10.Nazeer SS, Asish R, Venugopal C, Anita B, Gupta AK, Jayasree RS. Noninvasive assessment of the risk of tobacco abuse in oral mucosa using fluorescence spectroscopy:a clinical approach. J Biomed Opt. 2014;19:057013. doi: 10.1117/1.JBO.19.5.057013. [DOI] [PubMed] [Google Scholar]