Which socio-demographic factors are associated with participation in oral cancer screening in the developing world? Results from a population-based screening project in India.
BACKGROUND
This study examines socio-demographic determinants of participation in a population-based randomized controlled trial that proved that oral visual inspection was effective in reducing oral cancer mortality in high-risk individuals in India.


METHODS
Multivariate logistic regression was used to establish socio-demographic characteristics of participants versus non-participants in the intervention arm. Compliance with referral was analysed according to the socio-demographic characteristics of screen-positives.


RESULTS
Of 96,517 eligible subjects, 87,655 were screened, 8688 individuals never received the invitation and 174 refused screening. Compared to the non-screened, a higher proportion of screened individuals were women (OR=4.51; CI: 4.28-4.75), lived in better housing (OR=1.35; CI: 1.25-1.41), had television/radio (OR=1.50; CI: 1.43-1.58) and were tobacco and alcohol users (OR=2.75; CI: 2.57-2.95). Being 65 and older decreased the chances of screening (OR=0.39; CI: 0.37-0.42), as well as living in high-size households (OR=0.73; CI: 0.68-0.78). Sixty-three percent of 5143 screen-positives complied with referral. Controlling for all other factors, individuals older than 44, and those with more advanced lesions were more likely to comply with referral (p<0.001). Individuals living in better housing were less likely to comply with referral (OR=0.79; CI: 0.65-0.95).


CONCLUSIONS
In summary, adequate coverage can be obtained in population-based oral screening in developing countries. The study underscores the important role of patient-provider communication in assuring high compliance with referral.
Ramadas
K
K
Regional Cancer Centre, Medical College Campus, Post Box 2417, Trivandrum 695 011, Kerala State, India.
Arrossi
S
S
Thara
S
S
Thomas
G
G
Jissa
V
V
Fayette
J M
JM
Mathew
B
B
Sankaranarayanan
R
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D003710:Demography; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000517:prevention & control*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012737:Sex Factors; D012959:Socioeconomic Factors