Implementation of downstaging for oral cancer requires several steps similar to cervical cancer:
A health education program to raise awareness of oral cancer, its links to tobacco use, and its curability when diagnosed early.
Users of tobacco are taught to examine their own mouths with a mirror and that of their friends in a “look a friend in the mouth” program to detect premalignant lesions.
Primary health care workers are trained to examine the mouth to identify premalignant lesions, and how to do case finding and to refer patients for diagnosis and treatment.
Again, a link is established between identification of an abnormality and a referral system for diagnosis, treatment and follow-up. The infrastructure for timely and effective surgical treatment must be accessible and in place. In most countries this maybe at regional or district hospitals.
An information system is needed to monitor and evaluate the program.