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Oral cancer

Study sites: Thiruvananthapuram (formerly called Trivandrum), Kerala, India
Principal investigator (PI) from IARC: R. Sankaranarayanan
PIs from collaborating institutions:K. Ramadas (PI), S. Thara, Beela Sarah Mathew, Elizabeth Abraham, Gigi Thomas, Jem Prabhakar, Paul Augustine, Ramani Wesley, R. Rejnish Kumar, Regional Cancer Centre (RCC), Thiruvananthapuram, Kerala, India
Start date: 1995
Closure date:Ongoing
  • To evaluate the efficacy of oral cancer screening by visual inspection in detecting early stages of oral cancer and in reducing mortality
  • To evaluate the cost-effectiveness of the intervention
Study outcomes: In 1996–2004, three rounds of oral visual inspection were provided by trained health workers at 3-year intervals to eligible individuals (aged ≥ 34 years) in the intervention group.

We reported a 35% decrease in mortality rate among the tobacco users/alcohol consumers of the intervention group compared with the control group. This evidence was used by India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) to support their recommendation of oral visual screening of the population.
Publications: Sankaranarayanan R., Ramadas K., Thara S., Muwonge R., Thomas G., Anju G., Mathew B. Long term effect of visual screening on oral cancer incidence and mortality in a randomized trial in Kerala, India. Oral Oncol. 2013;49(4):314-21.
PMID: 23265945
Ramadas K., Sauvaget C., Thomas G., Fayette J.M., Thara S., Sankaranarayanan R. Effect of tobacco chewing, tobacco smoking and alcohol on all-cause and cancer mortality: a cohort study from Trivandrum, India. Cancer Epidemiol. 2010;34(4):405-12.
PMID: 20444665
Subramanian S., Sankaranarayanan R., Bapat B., Somanathan T., Thomas G., Mathew B., Vinoda J., Ramadas K. Cost-effectiveness of oral cancer screening: results from a cluster randomized controlled trial in India. Bull World Health Organ. 2009;87(3):200-6.
PMID: 19377716
Sankaranarayanan R., Ramadas K., Thomas G., Muwonge R., Thara S., Mathew B., Rajan B.; Trivandrum Oral Cancer Screening Study Group. Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial. Lancet. 2005;365(9475):1927-33.
PMID: 15936419
Ramadas K., Sankaranarayanan R., Jacob B.J., Thomas G., Somanathan T., Mahé C., Pandey M., Abraham E., Najeeb S., Mathew B., Parkin D.M., Nair M.K. Interim results from a cluster randomized controlled oral cancer screening trial in Kerala, India. Oral Oncol. 2003 Sep;39(6):580-8.
PMID: 12798401
  • Worldwide Cancer Research, St Andrews, United Kingdom
  • Cancer Research UK, United Kingdom
Study sites: India: Ambilikkai, Bangalore, Barshi, Guwahati, Sevagram, Thiruvananthapuram
Principal investigator (PI) from IARC: M. Tommasino
PIs from collaborating institutions:
  • Kunnambath Ramadas, Regional Cancer Centre, Thiruvananthapuram
  • M. Radhakrishna Pillai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram
  • Pulikattil Esmy, Christian Fellowship Community Health Centre (CFCHC), Ambilikkai
  • Rekha V. Kumar, Kidwai Memorial Institute of Oncology, Bangalore
  • Manoj M. Lokhande, Nargis Dutt Memorial Cancer Hospital, Barshi
  • Ashok Kumar Das, Guwahati, Assam
  • Nintin Gangane, Mahatma Gandhi Institute of Medical Sciences, Sevagram
Start date: 2011
Closure date:Ongoing
Objectives: Overall objective
  • To elucidate the role of HPV types and other environmental risk factors in the development of head and neck cancers (HNCs) in Europe and India
Specific objectives:
  • To improve our understanding of the role of HNC etiology in geographical regions with different incidence rates
  • To identify the most clinically useful HPV markers and new biomarkers for various types of HNC, which can be used for screening and/or therapy strategies
  • To provide new insights on the natural history of HPV oral infection and its diagnosis, on HNC prognosis, and the association of survival with HPV status
Methodology:This is a multicentre study including recruiting centres in Europe and India. The Screening Group is collaborating with the Indian centres. Approximately 4000–6000 HNC specimens are collected from several Indian centres from rural or urban areas. The specimens include cancers of the hypopharynx, oropharynx, oral cavity, and larynx. Each Indian centre provides approximately 1000–1500 specimens representing the four anatomical sites. Epidemiological and clinical data are also collected when available.
Publications: Ursu R.G., Danciu M., Spiridon I.A., Ridder R., Rehm S., Maffini F., McKay-Chopin S., Carreira C., Lucas E., Costan V.V., Popescu E., Cobzeanu B., Ghetu N., Iancu L.S., Tommasino M., Pawlita M., Holzinger D., Gheit T. Role of mucosal high-risk human papillomavirus types in head and neck cancers in Romania. PLoS One. 2018 Jun 25;13(6):e0199663.
PMID: 29940024
Gheit T., Anantharaman D., Holzinger D., Alemany L., Tous S., Lucas E., Prabhu P.R., Pawlita M., Ridder R., Rehm S., Bogers J., Maffini F., Chiocca S., Lloveras B., Kumar R.V., Somanathan T., de Sanjosé S., Castellsagué X., Arbyn M., Brennan P., Sankaranarayanan R., Pillai M.R., Gangane N., Tommasino M.; HPV-AHEAD study group. Role of mucosal high-risk human papillomavirus types in head and neck cancers in central India. Int J Cancer. 2017 Jul 1;141(1):143-151.
PMID: 28369859
Mena M., Lloveras B., Tous S., Bogers J., Maffini F., Gangane N., Kumar R.V., Somanathan T., Lucas E., Anantharaman D., Gheit T., Castellsagué X., Pawlita M., de Sanjosé S., Alemany L., Tommasino M.; HPV-AHEAD study group. Development and validation of a protocol for optimizing the use of paraffin blocks in molecular epidemiological studies: The example from the HPV-AHEAD study. PLoS One. 2017 Oct 16;12(10)
PMID: 29036167
Funding: European Union
Study sites: Udaipur, India
Principal investigator (PI) from IARC: P. Basu
PIs from collaborating institutions:Manoj Mahajan (PI), Kirti Jain, Nilesh Patira, GBH Memorial Cancer Hospital, Udaipur, India
Start date: 2017
Closure date:Ongoing
Objectives: To evaluate the feasibility and acceptability of the model of delivering community health worker (CHW)–driven home-based comprehensive noncommunicable disease (NCD) control services aimed to prevent premature deaths from cardiovascular diseases; stroke; and breast, cervical, and oral cancers in hard-to-reach men and women
The implementation research has two main components, which will be conducted simultaneously:
  1. Evaluation of the social, cultural, and behavioural factors that impact the uptake of the NCD prevention and control services among women, using the RARE methodology
  2. Evaluation of the feasibility and acceptability of delivery of the NCD early detection services by the trained community health workers in home settings
Participants will be screened for hypertension, diabetes, oral cancer (for habitual users of tobacco products and/or consumers of alcoholic beverages), and cervical cancer (for women only, by HPV testing on self-collected specimens). Women will be made aware of common symptoms and signs of breast cancer. All services will be provided at home. The screen-positive men and women will be navigated to reach appropriate diagnostic and treatment centres.
Publications: Basu P., Mahajan M., Patira N., Prasad S., Mogri S., Muwonge R., Lucas E., Sankaranarayanan R., Iyer S., Naik N., Jain K. A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India. BMC Public Health. 2019 Jan 3;19(1):14.
PMID: 30606132
Mahajan M., Naik N., Jain K., Patira N., Prasad S., Mogri S., Muwonge R., Lucas E., Faruq F., Sankaranarayanan R., Iyer S., Basu P. Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol. 2019 Apr;(5):1-10.
PMID: 30998427
Funding: American International Health Management Ltd

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