Device manufacturer customizes Android such that this setting can be toggled from within the default device settings activity.
There is no customization needed. This is available in the Developer Options area.
Custom Android build (e.g. Cyanogen) has been configured to have it "on" by default.
One hopes that nobody does this.
User downloads some sort of "power tool" allowing him to tweak the default system settings.
Again, this is part of Android, so no "power tool" is needed.
How likely are each of these?
Not very. I'd be surprised if it is more than one device in 10,000. If your app cannot handle this setting (and I suspect that few apps do), and you are worried about it, feel free to check the setting and display something to the user to have them go revert the setting.