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

Abstract

This study evaluates the effectiveness of Taiwan's nationwide oral cancer screening programme in reducing late-stage diagnosis, treatment delays and mortality. A retrospective cohort study was conducted. The study utilized Nationally representative datasets, including the Cancer Registry, Oral Mucosal Screening and National Health Insurance databases in Taiwan. 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. The intervention was Taiwan's nationwide oral cancer screening programme which provides visual inspection and palpation of the oral mucosa. 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. 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). 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.