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

Abstract

Background Oral 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. Methods In 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. Results One 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. Conclusions We 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.

Characteristics and in-hospital morbidity trends associated with oral and oropharyngeal cancers in Brazil

“…This expansion of coverage of primary care combined with a greater possibility of access to treatments in the hospital network, would result in lower mortality rates but in greater in-hospital morbidity [ 33 ]. Another study indicated the association between the increase in the number of oral health teams and the timely diagnosis of oral and oropharyngeal cancers [ 12 ].…”

“…It is worth mentioning that the inclusion and expansion of the family health network in Brazilian communities has shown the potential to reach the population at risk for the development of oral and oropharyngeal cancer [ 31 , 32 ]. In this sense, a recent study shows that the inclusion of oral health teams is associated with early and timely detection of these diseases [ 12 ].…”

“…In turn, an early diagnosis favors the implementation of usually less invasive and more effective treatments [ 5 ]. Behaviors associated to primary prevention, early detection and adequate and timely treatment are associated, among other factors, to the organization and quality of the provided health services [ 11 , 12 ]. In fact, the incorporation of the monitoring of morbidity and mortality from cancer in the health management routine is of utmost importance to implement actions aimed at preventing and controlling cancer and its risk factors [ 13 , 14 ].…”

Câncer bucal: o que sabem os cirurgiões-dentistas da Baixada Litorânea-RJ?

“…A Atenção Primária à Saúde (APS), na Região de Saúde da Baixada Litorânea, tem a sua constituição em unidades de saúde da família, em unidades tradicionais e na Odontoclínicas. A pesquisa evidenciou que 45,6% dos profissionais atuam na Estratégia de Saúde da Família (ESF), sendo este atualmente o modelo preferencial de assistência, devido a sua responsabilidade com a saúde da população, formação de vínculos, trabalho com grupos prioritários e em rede de atenção, que são atributos importantes da APS para uma saúde bucal de qualidade 15 . Observou-se um dado importante com relação ao vínculo dos profissionais: embora a maioria fosse estatutária, houve um número significativo de profissionais contratados, o que pode impactar de maneira negativa no processo de educação permanente dos profissionais, já que mudanças constantes de cirurgiões-dentistas decorrentes de contratos de trabalho de 1 ano, que podem ser renovados ou cancelados a qualquer momento, podem dificultar a manutenção de um quadro de profissionais capacitados e focados, prejudicando, dentre outras, as ações de prevenção e diagnóstico precoce do câncer de boca.…”

Factors related to the waiting time for scheduling an oral biopsy in Brazil: a multilevel analysis

“…The availability of access to health services that offer the necessary care in a timely manner is crucial for this outcome. The delay in diagnosing this disease is a matter of concern and a prevalent one – most oral neoplasms are detected at an advanced stage [ 10 – 12 ]. A study that analyzed the relative survival of oral cancer in several health institutions in South America identified that around 48% of the patients included in the study were diagnosed with tumors at the most advanced stage, i.e., stage IV.…”