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

The Brazilian National Oral Health Policy and oral cancer mortality trends: An autoregressive integrated moving average (ARIMA) model

OBJECTIVE

This study analyzes the effect of the Brazilian National Oral Health Policy (NOHP) on oral cancer mortality rates (OCMR).

METHOD

This is an ecological study with secondary oral cancer death data, using interrupted time series analysis (ARIMA, Autoregressive Integrated Moving Average). Annual death data were collected from the Mortality Information System (1996-2019). The outcome was the OCMR, standardized by gender and age We considered the NOHP, categorized as "0" (before its implementation), from 1996 to 2004, and "1 to 15", from 2005 to 2019. ARIMA modeling was carried out for temporal analysis, and regression coefficient estimation (RC).

RESULTS

The Brazilian NOHP implementation was associated with an increase in OCMR in the North region (CR = 0.16; p = 0.022) and with a decrease in the Southeast region (CR = -0.04; p<0.001), but did not affect the other macro-regions nor Brazil. The forecast models estimated an increase in OCMR for the North, and Northeast, a decrease for the Southeast, and stability for the South and Brazil.

CONCLUSION

The Brazilian NOHP is not being effective in reducing the OCMR. The trends behaved differently in the Brazilian territory, highlighting health inequities. We recommend that the NOHP strengthen the oral health care network, incorporating oral cancer as a notifiable disease, adopting strategies for prevention, screening, and providing opportunities for early treatment of the disease.

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

BACKGROUND

Timely diagnosis of oral cancers is critical, and performing biopsies of oral lesions with suspected malignancy is a crucial step in achieving this goal. The waiting time for the diagnosis may be related to the progression and prognosis of malignant neoplasms.

OBJECTIVE

The aim of this observational, cross-sectional, national-level study was to identify the factors associated with the waiting time for scheduling an oral biopsy, based on the identification of its need.

METHODS

We used secondary data from the Brazilian public health system, obtained from the 2nd cycle of the National Program to Improve Access and Quality of Dental Specialty Centers (PMAQ-CEO). The study outcome was the waiting time for scheduling an oral biopsy, starting from the identification of the need for the exam. We analyzed individual and contextual variables using multilevel statistical analysis.

RESULTS

In 51.8% of DSC the waiting time for scheduling a biopsy was non-immediate; in 58.1% of CEOs, the sum of the weekly workload of dentists working in the Stomatology specialty is up to 20 h per week; in terms of coverage, 67.1% of the CEOs have only municipal coverage and 34.0% are references for up to 12 oral health teams in primary health care; only the coverage variable remained significant in the multivariate model (p < 0.05). Of the contextual variables, none of the variables remained significant (p > 0.05). When these were analyzed together, only the coverage remained significant (p < 0.05); CONCLUSION: Our analysis indicates that the waiting time for scheduling an oral biopsy is longer in CEOs that cover only one municipality and is not related to contextual factors.

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

BACKGROUND

Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system.

METHODS

Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method.

RESULTS

Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions.

CONCLUSIONS

It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.

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

Resumo Introdução Apesar das estratégias para prevenção e diagnóstico precoce, o câncer bucal está entre os mais incidentes no Brasil. Objetivo Avaliar o conhecimento de cirurgiões-dentistas da Atenção Primária à Saúde sobre o câncer bucal. Material e método Pesquisa censitária, exploratória e quantitativa, realizada em 2021. Cirurgiões-dentistas vinculados à rede pública dos 9 municípios da Baixada Litorânea/RJ preencheram um questionário com 41 questões, divididas em 5 blocos: 1. Perfil sociodemográfico, 2. Conhecimento sobre câncer bucal, 3. Fatores de risco para câncer bucal, 4. Segurança para diagnóstico do câncer bucal e 5. Experiência na identificação de lesões suspeitas. Resultado Dos 128 cirurgiões-dentistas habilitados, 89,1% (n=114) participaram e caracterizavam-se por terem menos de 40 anos (50%), serem do sexo feminino (64,9%) e formados há mais de 16 anos (57,9%). Quanto ao conhecimento sobre o câncer bucal e fatores de risco, 84,2% consideraram seu nível de conhecimento regular ou bom e 65,8% consideraram baixo o seu nível de segurança para realização de procedimentos de diagnóstico do câncer bucal. Quanto à identificação de lesões suspeitas de câncer bucal, 86,8% realizavam exame da cavidade bucal, 7,9% não realizam porque o tempo da consulta é insuficiente e 5,3% porque não sabem fazer. Além disso, 50,9% identificaram alguma lesão suspeita nos últimos 12 meses. Notou-se também que 65,8% dos CDs não tinham conhecimento do fluxograma do município para diagnóstico e tratamento do câncer bucal. Conclusão Os achados evidenciaram lacunas com relação ao conhecimento e procedimentos para diagnóstico precoce do câncer bucal.