A Qualitative Inquiry into the Knowledge, attitudes/beliefs and practices of health practitioners in Puerto Rico as they relate to oral cancer risk awareness, prevention, detection, and care

Age-adjusted oral cancer incidence and mortality rates for Puerto Rico are among the highest in the Western Hemisphere, particularly among males. Most oral cancers are squamous cell carcinomas; it is generally agreed that such lesions should be biopsied and evaluated histopathologically, yet oral precancers and early cancers are often asymptomatic and can go undetected in the absence of a careful oral examination. Previous analyses indicate a significant disparity in the biopsying of a) potentially precancerous oral lesions and b) in situ oral cancers in Puerto Rico relative to the United States. Findings suggest that Puerto Rico residents with intraoral lesions suspicious for oral cancer or precancerous are most likely to be biopsied only after developing an invasive cancer. To address the shortfalls in the early detection of precancerous and early-stage oral cancer in Puerto Rico, it is critical that the underlying causal factors first be identified and understood. Therefore, the main objective of the ongoing project has been to gain insight into the knowledge, attitudes/beliefs and practices of a) health practitioners in Puerto Rico (general dentists, primary care physicians, ENTs, oral surgeons, expanded-duty dental assistants) as they specifically relate to oral cancer risk awareness, prevention, detection, and care. The project was conducted from qualitative health research methodology, and included key informant interviews to oral health care professionals, and analysis of relevant documents as health insurance and national and oral health international institutional guidelines. Recommendations for further research and policy and practice implications will be presented. Supported by NIDCR/NIH U54 DE14257.