{"entity":{"id":"paper-sankaranarayanan-oral-screening-lancet-2005","kind":"paper","name":"Effect of screening on oral cancer mortality in Kerala, India","aka":[],"tldr":"Visual examination of the mouth by trained health workers reduced oral cancer deaths by a third among tobacco and alcohol users in Kerala, the only randomised evidence that oral cancer screening works.","summary":"Cluster-randomised trial in 13 clusters of Trivandrum district: 96,517 people in seven intervention clusters received three rounds of oral visual inspection by trained health workers and 95,356 in six control clusters received usual care. Oral cancer deaths were 77 versus 87 (mortality rate ratio 0.79; 95% CI 0.51-1.22 overall), with a significant reduction in tobacco or alcohol users (0.66; 95% CI 0.45-0.95) and in male users (0.57; 0.35-0.93). The 15-year follow-up (Oral Oncology 2013) showed a 24% mortality reduction in users after four rounds and 81% (69-89%) in users who attended all four rounds.","asOf":"2026-09-10","links":[{"label":"Lancet 2005","url":"https://doi.org/10.1016/S0140-6736(05)66658-5"},{"label":"15-year follow-up (Oral Oncology 2013)","url":"https://doi.org/10.1016/j.oraloncology.2012.11.004"}],"tags":[],"related":[],"cancers":["head-and-neck"],"sections":[],"technologies":["chemoprevention"],"targets":[],"drugs":[],"companies":[],"institutions":["iarc"],"pathways":[],"terms":[],"trials":["kerala-oral-screening"],"people":["sankaranarayanan-rengaswamy"],"bottlenecks":["b-early-detection","b-prevention-adoption"],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2005,"doi":"10.1016/S0140-6736(05)66658-5","authors":"Sankaranarayanan R, Ramadas K, Thomas G, et al.","paperType":"rct","findings":["Oral cancer mortality rate ratio 0.79 overall (not significant) and 0.66 in tobacco or alcohol users (significant).","Male tobacco or alcohol users: rate ratio 0.57.","15-year follow-up: 81% lower oral cancer mortality in users who attended all four screening rounds, and 38% lower incidence.","Screening was done by trained non-medical health workers, not dentists or doctors."],"whatItMeans":"Targeted visual screening of tobacco and alcohol users is a cheap, workable way to cut oral cancer deaths in high-incidence countries, and is the basis for India's national oral cancer screening component. Its effect depends on people attending repeatedly and on treatment being available.","caveats":["Overall (all-comer) mortality reduction was not statistically significant; the benefit is concentrated in high-risk users.","Cluster trial with 13 clusters, which limits precision.","Compliance with referral and treatment was incomplete, so real programmes may achieve less."],"changedPractice":true,"participants":191873},"route":"/key-papers/paper-sankaranarayanan-oral-screening-lancet-2005/","neighbours":{"cancer":[{"id":"buccal-mucosa-cancer","kind":"cancer","name":"Buccal mucosa and gingivobuccal cancer (oral cancer in India)","route":"/cancers/buccal-mucosa-cancer/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"oral-cavity-cancer","kind":"cancer","name":"Oral cavity cancer (mouth and tongue)","route":"/cancers/oral-cavity-cancer/"}],"technology":[{"id":"chemoprevention","kind":"technology","name":"Chemoprevention & risk-reducing surgery","route":"/technologies/chemoprevention/"}],"institution":[{"id":"iarc","kind":"institution","name":"International Agency for Research on Cancer (IARC / WHO)","route":"/institutions/iarc/"}],"trial":[{"id":"kerala-oral-screening","kind":"trial","name":"Kerala oral cancer visual screening trial (Trivandrum)","route":"/trials/kerala-oral-screening/"}],"person":[{"id":"sankaranarayanan-rengaswamy","kind":"person","name":"Rengaswamy Sankaranarayanan","route":"/people/sankaranarayanan-rengaswamy/"}],"bottleneck":[{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}]}}