Inclusion of oral health teams in primary health care promotes early diagnosis of oral and oropharyngeal cancers: a nationwide study

Deborah Gomes De Miranda Vargas,Livia Fernandes Probst,Amanda Ramos Da Cunha,Paulo Zárate-Pereira,Edílson José Zafalon,Elaine Pereira Da Silva Tagliaferro,Alessandro Diogo De-Carli

doi:10.1186/s12903-021-01664-3

Abstract

BackgroundOral and oropharyngeal cancers are considered important public health problems worldwide. This study aims to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variables and coverage of Primary Health Care (PHC), and to assess the temporal trend of late diagnosis.MethodsIn this cross-sectional observational study, secondary data were evaluated with a time series analysis. All Brazilian cities that reported at least one case of oral and oropharyngeal cancers each year in the period between 2000 and 2013 were included; and the staging was analyzed by calculating the ratio risk for late diagnosis for each municipality. The association between staging and socioeconomic variables and offer of PHC was calculated using multiple linear regression. The time trend of the risk ratio for late-stage diagnosis was calculated using the Prais–Winsten method.ResultsOne hundred and sixty Brazilian municipalities had at least one annual case of oral and oropharyngeal cancers notified to the INCA hospital system between 2000 and 2013. The adjusted model showed that the higher the Gini value (greater social inequality) and the lower the HDI value (less human development) was, the higher was the number of tumors diagnosed at a late stage, considering the size of the tumor. A greater risk for late diagnosis was identified, as early as at the stage of lymph node involvement, when there was a higher level of social inequality and lower level of coverage by Oral Health Teams (OHT) in PHC. The greater the social inequality, the greater was the risk of late diagnosis, as early as in the stage of metastasis.ConclusionsWe concluded that, during the evaluated period, there was an increase in the number of cases diagnosed at the most advanced stage. Furthermore, there was association between higher levels of social inequality and an increase in the proportion of late diagnosis of oral and oropharyngeal cancers. In addition, the inclusion of Oral Health Teams in Primary Health Care promoted the early diagnosis of these types of cancers.

Highlights

Oral and oropharyngeal cancers are considered important public health problems worldwide
In view of the foregoing facts, the aim of this study was to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variations and Primary Health Care (PHC) coverage, including individualized assessment of the coverage provided by the Oral Health Teams (OHT), and assessing the temporal trend of late initial diagnosis
One hundred and sixty Brazilian municipalities had at least one case per annum of oral and oropharyngeal cancers notified to RHC-INCA between the years 2005

Summary

Introduction

Oral and oropharyngeal cancers are considered important public health problems worldwide. Oral and oropharyngeal cancers are considered important public health problems worldwide, due to their high incidence, mortality and the high clinical-care costs associated with them [1,2,3]. The timely diagnosis and adequate treatment, among other factors, are associated with the organization and quality of health services offered. In this sense, Brazil has experienced an increase in the population’s access to oral health care [5, 6] after the Unified Health System (SUS, Sistema Único de Saúde) was created. Based on the concept of multiprofessional work, the OHT must recognize local vulnerabilities and the possibilities of intersectoral partnerships to achieve comprehensive care and work based on the principles and values of health promotion [7, 8]

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