Methods: Ten screening sites were established within public and private dental clinics, indigenous health clinics and a community pharmacy. Risk assessment was undertaken through a semi-structured interview and self-directed questionnaire. Oral mucosal examination was completed by one of 11 trained and calibrated dentists or oral health therapists, under conventional operatory parameters. Participants at selected sites were also examined with adjunctive optical diagnostic aids.
Results: The study ran for 24 months from April 2012 to April 2014. A total of 1,498 participants consented to oral mucosal screening, with complete data available for 1,252 (83.6%). Almost half (n=561; 44.8%) were from a background of high disadvantage, and 59.9% reported annual household incomes below $40,000AUD (n=750). Participants from backgrounds experiencing the highest level of disadvantage were more likely to have a history of tobacco use (p=0.04), and present with suspicious oral mucosal lesions (p=0.01). Examiners reported difficulties in recruitment, which stemmed mainly from patient refusal due to time constraints, disinterest or embarrassment relating to their oral condition. Clinician outreach also proved inefficient in participant recruitment.
Conclusion: Mass screening for oral cancers and their preceding lesions has been shown as a viable public health initiative in high risk populations. In the Australian context, participant recruitment appears to be a significant barrier in implementation, and further efforts to improve uptake of the program is needed for its success.