Tobacco usage in India is one of the largest preventable cause of non-communicable diseases such as oral cancer, lung cancer, obstructive lung disease and cardiovascular disease, to name a few. Consumption of tobacco in smoked forms (e.g., cigarettes, bidis, cigars, hookah) and smokeless forms (e.g., Gutkha, zarda, khaini) kills nearly a million users annually- all entirely preventable premature deaths.

With nearly 300 million current users of risky tobacco in India, of which 200 million chew smokeless tobacco, the tobacco use epidemic and the resultant deaths from cancers and other preventable diseases are unlikely to abate for the foreseeable future. The effects of smokeless tobacco are most pronounced in the oral cavity, manifesting as submucosal fibrosis, leukoplakia and oral cancers. The incidence of oral cancer in India is among the highest worldwide, comprising nearly half of all oral cancers globally. Already, smokeless tobacco kills more than 350,000 people every year in India. Particularly concerning is the disproportionately higher use of smokeless tobacco among socio-economically disadvantaged groups, women and the rural population. For example, tobacco chewing is common among migrant construction workers, those living in urban slums, truck and metro transport drivers. In the case of pregnant women chewing tobacco, their tobacco use harms them as well as their babies with an increased risk of anaemia, higher rates of stillbirth and lower weight of the newborn.

The user groups of smokeless tobacco often have a poor understanding of tobacco harms and cessation aids, along with poor access to healthcare. Cessation aids in the form of behavioural support and safer nicotine alternatives to smokeless tobacco are not affordable, accessible or available to the majority of the population.

Screening for pre-malignant and early-stage oral cancers can be done by experts by visual inspection. However, if the person at the point of care (POC) who is screening is not skilled and experienced, then the sensitivity and specificity of the visual diagnosis can be very low. This is generally the case in rural healthcare settings. As a result, tobacco user patients from rural and disadvantaged backgrounds are more likely to present late with stage III or stage IV oral cancer. Currently in India, overall survival following treatment at 5 years for Stage I oral cancer is 100% and decreases to 85% for Stage II. For Stages III and IV, 5-year survival can be a mere 43% and 42% respectively. This is further worsened due to lower affordability and access to chemotherapy and radiotherapy for most of the rural populations.

Early screening of pre-cancerous oral lesions such as Leukoplakia and Erythroplakia complemented by opportunistic and comprehensive tobacco cessation support has the potential to be a significant and impactful public health intervention. This is where ORAICLE believes that a well-designed, robustly tested and scientifically validated Artificial Intelligence (AI) algorithm can be a game-changer, and ORAICLE intends to develop an Artificial Intelligence Algorithm that can analyze images of the oral cavity at the POC and categorize the lesions as cancerous or non-cancerous and “red flag” them for further expert evaluation.