Dear Editor,
Oral cancer is a public health problem that reduces the quality of life of patients and is potentially mortal. Worldwide, WHO estimates that there are 657,000 new cases of oral cavity and pharyngeal cancers each year, and more than 330,000 deaths [1]. In recent years, the burden of the disease has increased, impacting mostly in countries with fewer economic resources, such as Peru [2].
According to the latest epidemiological analysis conducted throughout the country in 2018, Peru had an incidence of lip and oral cavity cancer of 705 new cases per 100,000 inhabitants [2]. Despite the government's efforts to stop the increase in cancer cases through strategies to strengthen oncology services in Peru, the screening for the evaluation of potentially malignant oral lesions has a scenario with different results if comparing rural and urban areas [2] This concurs with what was mentioned by the World Health Organization in 2018, where it highlights the need to close inequality gaps and ensure an equitable distribution of health services, especially in rural and remote communities [3].
Strengthening strategies to reduce oral cancer morbidity and mortality include prevention and health promotion programs through careful evaluation of the oral cavity, health literacy campaigns, and identification and control of risk factors (exposure to high consumption of alcohol, tobacco, sun exposure from fieldwork, etc.) [1], [4], [5].
In Peru, oral cancer prevention programs that include detection of precancerous oral lesions in rural areas often face particular challenges, such as poorly resourced health centers, limited access to health services, increased poverty, illiteracy, and accessibility problems of the population (because health centers are far from their workplaces or home) [2]. Additionally, during this pandemic, other limitations are being added to the evaluation of the oral cavity in rural areas, such as:
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In the current health context, resolutive treatments are preferred in dentistry, leaving preventive health in the background [6]. Even before the pandemic, oral cancer prevention campaigns through self-assessment and early detection of oral lesions were little implemented in health centers due to lack of financial-administrative resources [2]. Moreover, patients did not attend due to various factors such as the distance from their home to the health center, the lack of flexibility in working hours, or the weather. Currently, preventive oral health programs have been further neglected.
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The existence of inaccessible rural areas hinders the continuous assistance of specialized health personnel.
In rural areas of Peru, even before the pandemic, dentists who performed the examination of the oral cavity and found some lesions suspected of being precancerous, referred the patient to more complex hospitals for a more exhaustive evaluation and to perform ancillary tests such as biopsies, among others. Nonetheless, many of the patients do not attend due to the problems described above (these hospitals are far from their health center, long time to wait for a single appointment, weather factors, etc.) [2] Besides, in this pandemic, general dentists over 65 years of age do not attend, which has caused a percentage of health establishments to have reduced opening hours or even had to close [7].
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Peru is a multiethnic and multicultural country, so the diversity of native languages represents, in most cases, barriers to preventive care and health promotion of oral cancer [2].
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In Peru, in urban areas, teledentistry (including teleconsultation, telemonitoring [which focuses on the treatment of dental emergencies and the follow-up of postoperative patients] and teleorientation [focused on the promotion and prevention of oral health]) can compensate for some of the deficiencies mentioned [6], [7], [8], [9]. However, its implementation in rural areas is complicated, due to internet access difficulties, telephone network coverage problems, and weather problems.
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During the pandemic, these disparities in oral health care between urban and rural areas have increased and threaten the implementation of prevention and health promotion campaigns in the control of oral cancer. These disparities between rural and urban areas in Peru are not that different from those in other countries like India (lower middle income), Asia (upper middle income), etc [10].
Yang et al. [11] mentioned that in rural and remote areas it is necessary to promote the implementation of online dental consultation, to massify oral health campaigns. Additionally, personalized online care would be important in identifying patients who have risk factors for oral cancer.
Based on this, oral health strategies need to know the impact of the pandemic on the early diagnosis of oral cancer in rural populations. Moreover, to make aware and sensitize about the importance of its timely detection and create cooperative alliances that allow the implementation of health programs to improve the effect and impact indicators of oral cancer prevention programs.
Funding
The present article was self-funded by the authors.
Author contributions
Authors participated in the conception and the writing of the manuscript and approved its final version.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References
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