title: Smokeless Tobacco-associated Lesions: A Mobile Health Approach.
abstract: Globally, India accounts for the highest number of oral cancer cases. The survival rates are about 30% lower than those in developing countries. The main reason for these dismal figures is the late presentation of patients. In order to downstage oral cancer in such a scenario, screening and diagnosis at an early stage is warranted. A pragmatic approach is needed for an oral cancer screening program, hence a mobile health (mHealth) approach was used. In this approach, health workers were empowered with mobile phones with decision-based algorithm. Risk stratification of tobacco habit enables us to identify lesions associated with particular habits.
  
  
  
  A specific cohort of factory employees who predominantly had pure tobacco chewing habit was chosen to examine the effect of pure tobacco on oral mucosa. One thousand three hundred and fifty-seven subjects were screened in two phases. In the first phase, habits and oral lesions were identified and photographed. The photographs were remotely diagnosed by an oral medicine specialist and those subjects requiring biopsy were recalled for phase II. Cytology and biopsy were performed in phase II.
  
  
  
  The predominant habit was smokeless tobacco (SLT), in 582 subjects. The most commonly encountered lesion was tobacco pouch keratosis seen in 397 subjects. Biopsy was performed for 71 subjects, most cases showed hyperkeratosis and mild dysplasia. One subject had moderate dysplasia.
  
  
  
  There was minimal alteration of tissues in our study subjects, which can be considered as low-risk. Use of mHealth empowered frontline healthcare workers to identify subjects with lesions and enabled remote diagnosis by specialist in resource-constrained settings.
  
  
  
  Use of mHealth enabled us have an electronic record of subject details. This data shall be used for a planned follow-up of the same cohort after 3 years.
authors.affiliation: Biocon Foundation, Bengaluru, Karnataka, India.
authors.forename: Rani
authors.initials: R
authors.lastname: Desai
authors.affiliation: Professor and Head, Department of Oral Medicine and Radiology, Biocon Foundation KLE Society's Institute of Dental Sciences, Bengaluru Karnataka, India, e-mail: praveen_birur@yahoo.com.
authors.forename: Praveen
authors.initials: P
authors.lastname: Birur
authors.affiliation: Biocon Foundation, Bengaluru, Karnataka, India.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Bajaj
authors.affiliation: Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India.
authors.forename: A R
authors.initials: AR
authors.lastname: Shubhasini
authors.affiliation: Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India.
authors.forename: R
authors.initials: R
authors.lastname: Bhanushree
authors.affiliation: Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India.
authors.forename: G
authors.initials: G
authors.lastname: Shubha
authors.affiliation: Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India.
authors.forename: G
authors.initials: G
authors.lastname: Keerthi
authors.affiliation: Biocon Foundation, Bengaluru, Karnataka, India.
authors.forename: Vidya
authors.initials: V
authors.lastname: Tiwari
authors.affiliation: Biocon Foundation, Bengaluru, Karnataka, India.
authors.forename: Sanjana
authors.initials: S
authors.lastname: Patrick
authors.affiliation: Department of Oral and Maxillofacial Pathology, JSS Dental College and Hospital, Mysuru, Karnataka, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Hegde
authors.affiliation: Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysuru, Karnataka, India.
authors.forename: Sujit
authors.initials: S
authors.lastname: Shetty
authors.affiliation: Biocon Foundation, Bengaluru, Karnataka, India.
authors.forename: Vidya
authors.initials: V
authors.lastname: Nagabhushan
authors.affiliation: Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kankanala
authors.affiliation: Department of Oral Medicine and Radiology, Bharati Vidyapeeth Dental College, Navi Mumbai, Maharashtra, India.
authors.forename: Shreyas
authors.initials: S
authors.lastname: Shah
mesh_terms: D015331:Cohort Studies; D055088:Early Detection of Cancer; D006801:Humans; D007194:India; D009062:Mouth Neoplasms / Q000175:diagnosis*; D012307:Risk Factors; D017216:Telemedicine; D064424:Tobacco Use; D014030:Tobacco, Smokeless / Q000009:adverse effects*
keywords: Cohort study; Mobile-health; Smokeless tobacco; Tobacco pouch keratosis