193 - Closing the Screening Gap: A Survivor-Led Model for Early Oral Cancer Detection in Rural India

Purpose/Objective(s): Oral cancer in rural India commonly presents at advanced stages due to widespread smokeless tobacco use, normalization of early symptoms, stigma, fragmented referral pathways, and delayed health-seeking. Conventional awareness campaigns often improve knowledge without translating into sustained screening behavior or timely diagnosis. Cancer survivors, whose lived experience confers strong peer credibility, represent an underutilized resource for community prevention and early detection. We evaluated the feasibility and impact of a survivor-led oral cancer screening intervention in rural southern India.

Materials/Methods: This prospective mixed-methods implementation study was conducted over two years across approximately 600 villages in southern Andhra Pradesh. Twenty disease-free head and neck cancer survivors delivered structured outreach through village meetings, school programs, informal community interactions, and folk-theatre performances with structured supervision & ongoing mentorship. Screening camps were conducted approximately one week after engagement to allow community diffusion. Primary outcomes included voluntary screening uptake and detection of potentially malignant oral disorders (PMODs) and oral cancers. Secondary outcomes included referral completion and community-initiated screening prompts. Outcomes were contextualized using historical outreach data from the same villages during the preceding 12 months. Quantitative outcomes were summarized descriptively, and qualitative interviews explored mechanisms of behavior change.

Results: Survivor-led activities reached approximately 51,000 individuals. Within four weeks, 3,420 participants voluntarily presented for oral screening (6.8%), representing a 21% relative increase compared with historical outreach. PMODs were identified in 286 individuals (8.4%). Forty-one oral cancers (1.2%) were confirmed histopathologically, of which 29 (71%) were detected at early stages (stage I–II). Referral completion improved from 54% at baseline to 78% during the intervention period. Notably, 38% of screenings were initiated by non-medical community intermediaries (family members, shopkeepers, barbers, teachers). Qualitative analysis identified three mechanisms driving engagement: embodied survivor credibility, narrative-driven risk perception, and distributed community vigilance through informal social networks.

Conclusion: A survivor-led community intervention was feasible in a dispersed rural setting and associated with increased screening uptake, improved linkage to care, and a substantial proportion of early-stage oral cancer detection. Survivor engagement represents a scalable, low-cost implementation strategy that may complement existing screening programs and reduce downstream treatment intensity through earlier stage presentation. These findings warrant validation through controlled designs and health-economic evaluation.