Predictors of Lesion Detection in a 12-Year Oral Cancer Screening Program: A Cohort Study in Northern Portugal

Abstract

Background

Oral cancer is a significant global public health issue, with high morbidity and mortality often linked to late diagnosis. This study evaluated a 12-year oral cancer screening program in northern Portugal to characterize its implementation and outcomes, identifying predictors of lesion detection. The program's outcomes were analyzed to assess its feasibility and contribution to early detection.

Methods

A retrospective analysis of screening program data from 2012 to 2024 was conducted. Participants were recruited through community outreach and selection of high-risk groups in primary care settings. A standardized oral/oropharyngeal examination protocol was used to classify lesions as benign, suspicious, or malignant based on clinical examination. Demographic data and risk factors were recorded, and individuals with suspicious or malignant lesions were referred for specialized evaluation.

Results

A total of 10 433 participants were screened (median age 63 years; 64% female). Oral lesions were detected in 16.7%, with 6.1% classified as suspicious and 0.2% malignant. Current smoking (OR = 1.65; p < 0.001), former smoking (OR = 1.27; p = 0.010), and previous oncological disease (OR = 1.74; p < 0.001) were associated with lesion detection on multivariable logistic regression. Overall, 16.4% of participants were referred for specialized consultation.

Conclusion

This large-scale screening program successfully reached a broad population, identifying a substantial number of potentially malignant lesions. The association with known risk factors supports the need for targeted screening strategies. Further research should integrate diagnostic confirmation, evaluate long-term patient outcomes, and assess cost-effectiveness to refine oral cancer screening policies and healthcare resource allocation.