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Impact of Community Oral Cancer Screening on Early Detection of Oral Lesions among Adults in Nigeria

Abstract

Oral cancer is an important public health concern that may result in significant morbidity, functional impairment, reduced quality of life, and mortality when diagnosis and treatment are delayed. Early identification of suspicious oral lesions provides an opportunity for timely clinical assessment, definitive diagnosis, treatment, and appropriate follow-up. However, many adults may not undergo routine oral examinations because of limited awareness, financial constraints, geographical barriers, low perceived risk, and inadequate access to oral healthcare services. Community oral cancer screening provides an opportunity to bring oral health assessment closer to populations and identify suspicious oral lesions that may otherwise remain undetected. Against this background, this study investigates the impact of community oral cancer screening on early detection of oral lesions among adults in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and 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 oral cancer screening. The Social Ecological Model emphasizes the influence of individual, interpersonal, community, healthcare, and broader environmental factors on access to and utilization of screening services. The Health Systems Framework highlights the importance of service delivery, health workforce, health information, medical technologies, financing, and accessibility in the effective delivery of community-based screening programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community oral cancer screening may influence early detection of oral lesions among adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above residing in selected urban and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, and eligible adults. Community oral cancer screening will be assessed using indicators such as availability of screening services, screening coverage, frequency of screening activities, accessibility of screening sites, availability of trained dental or healthcare personnel, screening procedures, use of appropriate examination equipment, referral arrangements, and follow-up systems. Early detection of oral lesions will be assessed using indicators such as identification of suspicious oral lesions, non-healing ulcers, persistent white or red patches, oral lumps or thickening, unexplained bleeding, abnormal areas requiring further assessment, referral for specialist examination, biopsy recommendation where clinically indicated, and confirmed diagnosis following appropriate clinical evaluation. Data will be collected using structured questionnaires, oral screening records, standardized oral examination checklists, referral registers, clinical records, and relevant community health programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening participation, and oral screening findings. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of community oral cancer screening on early detection of oral lesions. Where a quasi-experimental design is adopted, detection rates before and after implementation of community 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 oral cancer screening has a significant positive impact on the early detection of suspicious oral lesions among adults in Nigeria. Adults who participate in community-based screening are expected to have a higher likelihood of having previously unnoticed oral abnormalities identified than adults without access to screening services. Bringing screening closer to communities may reduce geographical, financial, and accessibility barriers while increasing opportunities for early clinical assessment and referral. Community screening may also improve public awareness of oral cancer warning signs and encourage timely healthcare-seeking for persistent oral abnormalities. However, limited availability of trained dental personnel, inadequate screening equipment, low community awareness, financial barriers to follow-up investigations, weak referral systems, and limited access to specialist oral healthcare may reduce the effectiveness of community screening programmes. The study therefore expects accessible, well-organized, adequately staffed, and properly linked community oral cancer screening programmes to contribute significantly to the early detection and appropriate management of suspicious oral lesions among adults in Nigeria. The study is expected to contribute to the literature on community oral cancer screening, early detection of oral lesions, oral cancer prevention, oral health services, community-based healthcare, screening programmes, healthcare-seeking behaviour, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, National Primary Health Care Development Agency, dental hospitals, primary healthcare centres, dentists, dental therapists, community health workers, cancer-control organizations, development partners, and policymakers regarding strategies for strengthening oral cancer prevention and early detection. The study will also provide evidence-based recommendations for expanding community oral cancer screening programmes, improving access to trained oral healthcare personnel and screening equipment, strengthening referral and follow-up systems, increasing community awareness, integrating oral cancer screening into primary healthcare and community outreach services, and improving access to appropriate diagnostic and treatment services across Nigeria.

Keywords: Community oral cancer screening, early detection, oral lesions, oral cancer, adults, oral health screening, cancer prevention, community health services, referral services, oral healthcare, Nigeria, public health.