The effectiveness of the oral cancer prevention and early diagnosis program in Sao Paulo, Brazil

Objective. To evaluate the results of the 2004 oral cancer prevention and early diagnosis program carried out in conjunction with the annual flu vaccination campaign for the elderly in the state of Sao Paulo, Brazil. Methods. Data concerning the follow-up of patients referred for diagnostic investigation of soft tissue lesions identified on visual inspection were collected from the reports issued by the State Health Department/Oral Health Technical Center. The following two characteristics were evaluated as indicators of the program's effectiveness: (1) the number of people whose problem was resolved at the primary care level or in referral services and (2) the number of persons with a confirmed diagnosis of oral cancer. The following indicators were used to assess program ineffectiveness: (1) patients not appearing at the referral unit, (2) inability of the primary care services to resolve the problem, and (3) the absence of follow-up information on patients. Results. In 2004, 238 087 people ! 60 years old were examined, corresponding to 6.8% of the state population in this age group (3 494 555 people). The program was carried out in 23 of the state's 24 health regions. However, only 8 of the regions recorded follow-up information. Of the 5 280 people in the 8 regions who were referred for diagnostic investigation of soft tissue lesions, 60.5% had their problem resolved, 0.5% (26 cases) had a confirmed diagnosis of oral cancer, and 22.5% did not have the diagnostic investigation completed. For 16.5% of the cases referred for further study, there was no information available concerning follow-up and outcomes. Conclusions. The oral cancer prevention and early diagnosis program was ineffective, given the lack of monitoring of results in most parts of the state of Sao Paulo, and the high proportion of patients whose soft tissue lesion was not resolved. The usefulness of continuing the program in future years needs to be evaluated.