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Effect of Community-Based Oral Cancer Screening on Oral Cancer Risk Detection among Adults in Nigeria

Abstract

Oral cancer is an important public health concern among adults in Nigeria and may affect the lips, tongue, gums, cheeks, floor of the mouth, and other parts of the oral cavity. Delayed recognition of suspicious oral lesions and other risk indicators may contribute to late presentation and increase the burden associated with diagnosis and treatment. Risk factors for oral cancer may include tobacco use, harmful alcohol consumption, certain infections, poor oral health, chronic irritation, and other behavioural and environmental exposures. Many adults may have limited awareness of early warning signs and may not routinely undergo oral health examinations, particularly where access to dental and oral healthcare services is limited. Community-based oral cancer screening provides an opportunity to identify suspicious oral lesions and other risk indicators among adults through community outreach programmes, primary healthcare centres, dental outreach services, mobile screening clinics, and other accessible community platforms. Early identification of suspicious findings may facilitate comprehensive oral examination, appropriate diagnostic evaluation, specialist referral, and timely management where necessary. However, limited awareness, financial constraints, geographical barriers, shortage of dental and oral health professionals, inadequate screening equipment, and weak referral and follow-up systems may restrict the effectiveness of community-based oral cancer screening in Nigeria. Against this background, this study investigates the effect of community-based oral cancer screening on oral cancer risk detection among adults in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how adults' perceptions of susceptibility to oral cancer, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in community-based oral cancer screening. The Social Ecological Model emphasizes the influence of individual, family, community, socioeconomic, behavioural, and environmental factors on oral health practices, cancer risk behaviours, healthcare-seeking behaviour, and access to preventive services. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective community-based oral cancer screening and referral programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based oral cancer screening may influence oral cancer risk detection among adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 18 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible adults. Community-based oral cancer screening will be measured using indicators such as availability of screening services, screening coverage, frequency of screening activities, oral cavity examination, assessment of suspicious oral lesions, evaluation of oral cancer risk factors, availability of trained dental or oral health personnel, screening equipment, oral cancer health education, and referral arrangements. Oral cancer risk detection will be assessed using indicators such as identification of suspicious oral lesions, non-healing oral ulcers, abnormal tissue changes, persistent oral patches, unexplained oral bleeding, oral symptoms requiring further assessment, identified behavioural or clinical risk factors, newly identified individuals requiring specialist evaluation, referrals for comprehensive oral examination, confirmatory diagnostic assessment where appropriate, and linkage to appropriate oral healthcare services. Data will be collected using structured questionnaires, community screening registers, oral examination forms, healthcare facility records, referral registers, and relevant community health programme documents. Descriptive statistics will be used to summarize participants' characteristics, oral health behaviours, screening coverage, examination findings, and patterns of oral cancer risk detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of community-based oral cancer screening on oral cancer risk detection. Where appropriate, oral cancer risk detection rates before and after implementation of community-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based oral cancer screening has a significant positive effect on oral cancer risk detection among adults in Nigeria. Adults who participate in community-based oral cancer screening are expected to have a higher likelihood of having previously unrecognized suspicious oral lesions or oral cancer risk indicators identified than adults without access to such services. Community-based screening may facilitate early recognition of suspicious oral changes and provide opportunities for comprehensive examination, appropriate diagnostic evaluation, and specialist referral where necessary. Bringing oral cancer screening closer to adults may reduce geographical, financial, and time-related barriers and encourage individuals who do not routinely visit dental or healthcare facilities to participate in preventive oral health assessments. Community-based oral health education may also increase awareness of oral cancer warning signs, tobacco and alcohol-related risks, oral hygiene, and the importance of seeking professional assessment for persistent oral abnormalities. Early identification of suspicious findings may improve opportunities for timely diagnosis and management. Conversely, inadequate screening coverage, limited access to dental professionals, shortage of trained screening personnel, low awareness, fear of cancer diagnosis, financial constraints, and weak referral and follow-up systems may reduce the effectiveness of community-based oral cancer screening. The study therefore expects accessible and well-organized community-based oral cancer screening to contribute significantly to improved detection of oral cancer risk indicators and early referral among adults in Nigeria. The study is expected to contribute to the literature on community-based oral cancer screening, oral cancer risk detection, oral health, cancer prevention, adult health, community health services, preventive healthcare, dental public health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, dental hospitals, dentists, oral and maxillofacial surgeons, community health workers, development partners, and policymakers regarding strategies for improving oral cancer prevention and early detection. The study will also provide evidence-based recommendations for expanding community-based oral cancer screening programmes, improving public awareness of oral cancer warning signs and risk factors, increasing access to trained dental and oral health professionals, strengthening oral examination and referral services, improving availability of appropriate screening resources, reducing financial and geographical barriers to oral healthcare, strengthening referral and follow-up systems, and integrating oral cancer risk assessment into appropriate community-based health programmes across Nigeria.

Keywords: Community-based oral cancer screening, oral cancer risk detection, adults, oral cancer, oral health, cancer prevention, suspicious oral lesions, dental public health, community health services, preventive healthcare, Nigeria, public health.