Cultural Competence: An Overlooked Factor in the Early Diagnosis of Oral Cancer?

Oral cancer remains a major global public health challenge, with an estimated 389,485 new cases and 188,230 deaths in 2022 (Bray et al. 2024). In Brazil, oral cancer is the fifth most frequent malignancy among men, with more than 15,000 new cases annually. Delays in diagnosis, often associated with limited professional preparedness and insufficient patient awareness, contribute significantly to morbidity and mortality (Passos et al. 2020). Interculturality, defined as reciprocal and respectful interaction between individuals from diverse cultural backgrounds (Deardorff 2006), has yet to be effectively integrated into healthcare practice. Cultural competence refers to the set of knowledge, attitudes, and skills that enable health providers to engage effectively with sociocultural diversity. It enhances communication, strengthens trust, and improves interpretation of symptoms and health behaviors (Kleinman and Benson 2006), and has emerged as an essential component of quality care. These attributes are particularly relevant for populations such as rural residents, Indigenous peoples, immigrants, LGBT individuals, and socioeconomically vulnerable groups, who frequently face communication barriers, stigma, and mistrust in health systems. The influence of cultural competence on oral cancer prevention and diagnosis remains largely unexplored. Given the centrality of communication in early detection, a critical question arises: could limited cultural competence among dental professionals hinder effective prevention and timely diagnosis of oral cancer? Evidence suggests that socially and culturally marginalized communities present higher rates of advanced oral cancer and poorer outcomes (Alkandari et al. 2023; Moon et al. 2022). Barriers in access to care undoubtedly play a role, but sociocultural factors, such as differing beliefs about illness, historical distrust, and inadequate provider sensitivity, may further delay diagnosis. When clinicians fail to recognize these dimensions, early symptoms may be overlooked or patient concerns minimized, perpetuating inequalities. Dental education in Latin America remains strongly biomedical with insufficient emphasis on communication and cultural diversity. Few regional studies have evaluated cultural competence among dental students or practitioners, and none in Brazil. A recent systematic review highlighted the need to incorporate intercultural awareness, cultural implications for families, and clinician–patient relationship dynamics into dental curricula (Álvarez-Cruces et al. 2024). These topics are vital for improving diagnostic accuracy and reducing disparities. Strengthening cultural competence requires curricular reform and continuing professional development. Although Brazilian National Curriculum Guidelines for Dentistry emphasize the formation of humanistic and socially responsible dentists, intercultural component still lacks a systematic approach. Effective strategies include simulation with culturally diverse scenarios, community-based experiences, case-based reflection, and training on unconscious biases and structural inequalities. Furthermore, it is fundamental that these strategies be discussed jointly with groups representing the full range of cultural diversity, and that the proposals be effectively implemented (Boyd 2025). No studies to date have examined how cultural competence influences early detection of oral cancer, a critical knowledge gap. Future research should integrate quantitative measures of diagnostic performance with qualitative assessments of patient–provider interaction. Evidence generated from such studies could guide policies and protocols that integrate sociocultural and linguistic dimensions into oral cancer screening and diagnosis, ensuring equity and preventing diagnostic delays among vulnerable populations. Danyel Elias da Cruz Perez: conceptualization, methodology, writing – original draft, writing – review and editing. Gabriele Gonçalves de Lima: investigation, methodology. Fernanda Gabriela Delfino Ferreira Oliveira: methodology, investigation. Andrea dos Anjos Pontual: writing – review and editing, conceptualization. Daniela da Silva Feitosa: conceptualization, writing – review and editing. This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. The authors declare no conflicts of interest.