DESCRIPTION (provided by applicant): Oral and oropharyngeal squamous cell carcinoma (OSCC) together rank as the sixth most common cancer worldwide, accounting for approximately 400,000 new cancer cases each year. About two-thirds of these cancers occur in low- and middle-income countries (LMICs), with very high rates in South and South-East Asian. While the 5-year survival rate in the U.S. for OSCC is 62%, the survival rate is only 10-40% and the cure rate around 30% in the developing world. Low survival rate is primarily attributed to the delay in diagnosis and the resultant progression of disease to an advanced stage at diagnosis. This problem is more acute in LMICs where least amount of resources is available for health care expenditure. Diagnosis is often delayed in marginalized at-risk populations living in rural areas with poor access to specialty health care, low health literacy, and problematic adherence to follow up. Early diagnosis offers the best chance to improved treatment outcomes and survival for an individual diagnosed with OSCC. Diagnosis of early oral lesions requires effective screening of the population. It is also important to detect and diagnose the chronic and malignant oral lesions, so efficient prevention and treatment strategies can be devised. We propose a mobile intra-oral imaging device and image platform to address the urgent need of a low-cost, portable, easy to use, and reliable imaging device for oral cancer screening in low resource settings. To achieve this goal, we have formed an international, multidisciplinary team with complementary expertise in engineering, oncology, and manufacturing/distribution. We have one of the largest cancer centers (Mazumdar- Shaw Cancer Center (MSCC), India) in LMIC to demonstrate the functionalities and validate clinical performance of the proposed device for oral cancer screening in low resource settings. We also have a collaboration with one of the largest dental companies (Carestream Health Inc) in the world to fabricate and distribute the products. We will develop prototypes in the UH2 Phase and demonstrate the functionalities and suitability in low resource setting at Roswell Park Cancer Institute and MSCC. In the UH3 Phase, we will refine the mobile intra-oral imaging device, and validate the clinical usefulness in four rural districts in Bangalore. This project is significant because early diagnosis of oral lesins and timely patient referral to specialists can reduce disease progression, reduce morbidity and mortality, and cut healthcare costs. We expect that use of this mobile based dual-modality screening approach for early diagnosis of oral cancers in community settings will eventually improve detection rates, treatment outcomes, and quality of life of patients.

PUBLIC HEALTH RELEVANCE: We propose a mobile intra-oral imaging system to address this urgent need of a low-cost, portable, easy to use, and reliable imaging device and method for oral cancer screening in low resource setting. We expect that this mobile based dual-modality screening approach for early diagnosis of oral cancers in community setting will eventually improve detection rates, treatment outcomes, quality of life of patients and reduce cost in low- and middle-income countries (LMICs).