Development and professional validation of an App to support Oral Cancer Screening

Rêgo, Talita Jordânia Rocha do; Lemos, José Vitor Mota; Matos, Amanda Pinheiro Leitão; Caetano, Caio Ferreira Freire; Dantas, Thinali Sousa; Sousa, Fabrício Bitu; Barros Filho, Edgar Marçal de; Silva, Paulo Goberlânio de Barros

doi:10.1590/0103-6440202204895

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Article • Braz. Dent. J. 33 (6) • Nov-Dec 2022 • https://doi.org/10.1590/0103-6440202204895 copy

Development and professional validation of an App to support Oral Cancer Screening

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study was to develop and validate an App for identifying risk factors for oral cancer. To this end, we developed an App (OCS: Oral Cancer Screening) with predictors of Oral Cancer (OC) and algorithm assembly to estimate the risk of its development. Methodology: Simulated clinical cases were designed so that 40 professionals with expertise in oral diagnostics could validate the algorithm and test its usability (SUS: System Usability Score) and acceptability (TAM: Technology Acceptance Model). Cronbach's alpha coefficient, Friedman/Dunn tests, and Spearman correlation evaluated the SUS and TAM scales. ROC curve was plotted to estimate the cutoff point of the algorithm in suggesting a high risk for OCS of the simulated cases. Chi-square and Fisher's exact tests were additionally used (p<0.05, SPSS v20.0). Results: Professionals with expertise in oral diagnosis had usability of 84.63±10.66 and acceptability of 84.75±10.62, which correlated positively (p<0.001, r=0.647). Acting in clinical areas of dentistry (p=0.034) and history of performing OC risk factor orientation (p=0.048) increased acceptability while acting in higher education increased usability (p=0.011). The cutoff point suggested by the App after validation of the simulated clinical cases showed high sensitivity of 84.8% and lower specificity of 58.4%. Conclusion: The OCS was effective and with adequate sensitivity, usability, and acceptability and may contribute to the detection of early oral lesions.

Key Words:
Squamous Cell Carcinoma; Family Health Strategy; Early Diagnosis; Mobile Apps; Smartphone

		SUS			TAM
	Total	Up to 80	>80	p-Value	Up to 80	>80	p-Value
Sex
Female	15 (37.5%)	7 (36.8%)	8 (38.1%)	0.935	5 (35.7%)	10 (38.5%)	0.864
Male	25 (62.5%)	12 (63.2%)	13 (61.9%)		9 (64.3%)	16 (61.5%)
Age
Up to 35	19 (47.5%)	9 (47.4%)	10 (47.6%)	0.987	9 (64.3%)	10 (38.5%)	0.119
> 35	21 (52.5%)	10 (52.6%)	11 (52.4%)		5 (35.7%)	16 (61.5%)
Majored
<10 years	21 (52.5%)	8 (42.1%)	13 (61.9%)	0.210	8 (57.1%)	13 (50.0%)	0.666
10+	19 (47.5%)	11 (57.9%)	8 (38.1%)		6 (42.9%)	13 (50.0%)
Professional Training
Stomatology	18 (45.0%)	9 (47.4%)	9 (42.9%)	0.775	6 (42.9%)	12 (46.2%)	0.842
SNP Dentistry	15 (37.5%)	9 (47.4%)	6 (28.6%)	0.220	7 (50.0%)	8 (30.8%)	0.231
Oral Pathology	9 (22.5%)	4 (21.1%)	5 (23.8%)	0.835	7 (50.0%)*	2 (7.7%)	0.002
OMST	11 (27.5%)	4 (21.1%)	7 (33.3%)	0.385	1 (7.1%)	10 (38.5%)*	0.034
Higher degree
Residency	2 (5.0%)	2 (10.5%)	0 (0.0%)	0.101	1 (7.1%)	1 (3.8%)	0.371
Specialization	4 (10.0%)	3 (15.8%)	1 (4.8%)		1 (7.1%)	3 (11.5%)
Masters	15 (37.5%)	4 (21.1%)	11 (52.4%)		3 (21.4%)	12 (46.2%)
Doctorate	19 (47.5%)	10 (52.6%)	9 (42.9%)		9 (64.3%)	10 (38.5%)
Time of last graduate degree in a related field
Up to 3 years	28 (70.0%)	11 (57.9%)	17 (81.0%)	0.112	10 (71.4%)	18 (69.2%)	0.885
>3 years	12 (30.0%)	8 (42.1%)	4 (19.0%)		4 (28.6%)	8 (30.8%)
Has another specialization
No	16 (40.0%)	6 (31.6%)	10 (47.6%)	0.301	5 (35.7%)	11 (42.3%)	0.685
Yes	24 (60.0%)	13 (68.4%)	11 (52.4%)		9 (64.3%)	15 (57.7%)

		SUS			TAM
	Total	Up to 80	>80	p-Value	Up to 80	>80	p-Value
Professional practice in oral diagnosis
Teaching	32 (80.0%)	12 (63.2%)	20 (95.2%)*	0.011	10 (71.4%)	22 (84.6%)	0.320
Private sector	27 (67.5%)	15 (78.9%)	12 (57.1%)	0.141	10 (71.4%)	17 (65.4%)	0.697
Public sector	14 (35.0%)	7 (36.8%)	7 (33.3%)	0.816	5 (35.7%)	9 (34.6%)	0.945
Has performed biopsies
No	11 (27.5%)	4 (21.1%)	7 (33.3%)	0.385	4 (28.6%)	7 (26.9%)	0.911
Yes	29 (72.5%)	15 (78.9%)	14 (66.7%)		10 (71.4%)	19 (73.1%)
Monthly biopsies
Up to 3	10 (34.5%)	7 (46.7%)	3 (21.4%)	0.153	5 (50.0%)	5 (26.3%)	0.202
>3	19 (65.5%)	8 (53.3%)	11 (78.6%)		5 (50.0%)	14 (73.7%)
Do you do biopsies of malignant lesions?
No	10 (25.0%)	3 (15.8%)	7 (33.3%)	0.201	4 (28.6%)	6 (23.1%)	0.702
Yes	30 (75.0%)	16 (84.2%)	14 (66.7%)		10 (71.4%)	20 (76.9%)
Do you do biopsies of potentially malignant lesions?
No	10 (25.0%)	3 (15.8%)	7 (33.3%)	0.201	4 (28.6%)	6 (23.1%)	0.702
Yes	30 (75.0%)	16 (84.2%)	14 (66.7%)		10 (71.4%)	20 (76.9%)
Risk factors for oral cancer
Smoke	40 (100.0%)	19 (100.0%)	21 (100.0%)	1.000	14 (100.0%)	26 (100.0%)	1.000
Alcohol	38 (95.0%)	18 (94.7%)	20 (95.2%)	0.942	14 (100.0%)	24 (92.3%)	0.287
HPV infection	38 (95.0%)	19 (100.0%)	19 (90.5%)	0.168	14 (100.0%)	24 (92.3%)	0.287
Sun exposure (lips)	40 (100.0%)	19 (100.0%)	21 (100.0%)	1.000	14 (100.0%)	26 (100.0%)	1.000
Unprotected oral sex	30 (75.0%)	14 (73.7%)	16 (76.2%)	0.855	14 (100.0%)*	16 (61.5%)	0.007
Advanced age	25 (62.5%)	9 (47.4%)	16 (76.2%)	0.060	10 (71.4%)	15 (57.7%)	0.392
Drug use	9 (22.5%)	5 (26.3%)	4 (19.0%)	0.583	2 (14.3%)	7 (26.9%)	0.361
Poorly fitted prostheses	9 (22.5%)	5 (26.3%)	4 (19.0%)	0.583	2 (14.3%)	7 (26.9%)	0.361
Unprotected sex	10 (25.0%)	6 (31.6%)	4 (19.0%)	0.361	4 (28.6%)	6 (23.1%)	0.702
Low socioeconomic status	15 (37.5%)	6 (31.6%)	9 (42.9%)	0.462	7 (50.0%)	8 (30.8%)	0.231
Immunosuppression	25 (62.5%)	10 (52.6%)	15 (71.4%)	0.220	10 (71.4%)	15 (57.7%)	0.392
Poor oral hygiene	12 (30.0%)	4 (21.1%)	8 (38.1%)	0.240	2 (14.3%)	10 (38.5%)	0.112
Advises on risk factors for oral cancer
No	2 (5.0%)	2 (10.5%)	0 (0.0%)	0.127	2 (14.3%)*	0 (0.0%)	0.048
Yes	38 (95.0%)	17 (89.5%)	21 (100.0%)		12 (85.7%)	26 (100.0%)*

Case	Risk Factors								Score
1	Brown/Black	Alcohol	Alcohol 2x a week						2,46
1	x1,33	x1,07	x1,73						2,46
2	Brown	Smoker	Pipe smoking	Smoking >20 yrs	Alcohol	Alcohol >2x a week	Distilled beverage	Drink >20 yrs	26.632,20
2	x1,33	x4,45	x5,06	x7,24	x1,07	x5,54	x5,87	x3,53	26.632,20
3	Brown	Sun exposure while work	Oral lesion						6477,1
3	x1,33	x4,87	x1000						6477,1
4	Black	Former smoker	Cigarette smoking	Smoking >20 yrs					14,48
4	x1,33	x1,38	x1,09	x7,24					14,48
5	Former drinker	Distilled beverage	Drink >20 yrs						56,57
5	x2,73	x5,87	x3,53						56,57
6	Black	Sun exposure during work	Alcohol	Distilled beverage	Alcohol>2x a week	Drink	Oral lesion		795585,7
6	x1,33	x4,87	x1,07	x5,87	x5,54	x3,53	x1000		795585,7
7	Brown								1,33
7	x1,33								1,33
8	Sun exposure during work	Smoker							21,67
8	x4,87	x4,45							21,67
9	Sun exposure during work								4,87
9	x4,87								4,87
10	Brown	Smoker	Cigarette smoking	Smoking >20 yrs	Alcohol	Alcohol >2x a week			276,87
10	x1,33	x4,45	x1,09	x7,24	x1,07	x5,54			276,87

	Referral (expert opinion)
	No	Yes	S	E	PPV	NPV	A	LR (95%CI)
Referral (App score > 10)
No	80	40	84.8%	58.4%	79.6%	66.7%	75.8%	7.82 (4.85 - 12.6)
Yes	57	223
Referral (App score > 20)
No	86	74	71.9%	62.8%	78.8%	53.8%	68.8%	4.30 (2.78 - 6.68)
Yes	51	189

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[1] Correspondence: Paulo Goberlânio de Barros Silva; Department of dentistry, Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil. Rua João Adolfo Gurgel, 133, Cocó, Fortaleza, Ceará, Brazil. CEP: 60192-345. E-mail: paulo_goberlanio@yahoo.com.br.