Can oral cancer screening reduce late-stage diagnosis, treatment delay and mortality? A population-based study in Taiwan

Abstract

Objective: This study evaluates the effectiveness of Taiwan's nationwide oral cancer screening programme in reducing late-stage diagnosis, treatment delays and mortality.

Design: A retrospective cohort study was conducted.

Setting: The study utilized Nationally representative datasets, including the Cancer Registry, Oral Mucosal Screening and National Health Insurance databases in Taiwan.

Participants: The study included patients with oral cancer diagnosed between 1 January 2010 and 31 December 2013, with follow-up through 31 December 2018. The final analysis included 16 430 patients.

Intervention: The intervention was Taiwan's nationwide oral cancer screening programme which provides visual inspection and palpation of the oral mucosa.

Primary outcome measures: The primary outcomes measured were late-stage diagnosis (stages III and IV), treatment delay (time from diagnosis to treatment >30 days) and all-cause mortality.

Results: Oral cancer screening was statistically significantly associated with a reduced likelihood of late-stage diagnosis (adjusted OR (AOR)=0.85, 95% CI 0.80 to 0.91, p<0.01). However, screening was also associated with a higher likelihood of treatment delay (AOR=1.09, 95% CI 1.00 to 1.19, p=0.049). Taken together, the screening programme is associated with a slightly lower hazard of death (adjusted HR=0.94, 95% CI 0.89 to 0.99, p=0.01).

Conclusion: While Taiwan's nationwide oral cancer screening programme effectively reduced late-stage diagnoses and mortality, barriers to timely treatment access remain. Ensuring prompt diagnosis and treatment following screening may further enhance the survival benefits of the programme.

Keywords: Health Services Accessibility; Mass Screening; PUBLIC HEALTH; Primary Prevention.