Effectiveness of Organized Strategies to Enhance Access to Preventive Oral Cancer Screening Among High‐Risk Individuals in Brazil: A Randomized Clinical Trial in Primary Care

This randomized clinical trial assessed the performance of organized, risk-based oral cancer (OC) screening strategies compared with the conventional opportunistic approach. Conducted from December 2023 to December 2024 across 35 primary health care (PHC) units in Rio de Janeiro, Brazil, the study included adults aged ≥ 35 years identified as tobacco users in the public electronic medical record system and considered high-risk for preventive oral examination (POE). PHC units were allocated to three groups: control (opportunistic screening without active invitation; 12 units), experimental I (organized invitation for POE plus home-visit support; 11 units), and experimental II (organized invitation for POE plus an awareness campaign; 12 units). The 23 PHC units implementing organized screening included 2735 registered tobacco users, whereas the 12 units maintaining opportunistic screening included 1048. Consequently, POE coverage reached 77.2% in the organized screening arms versus 3.6% under opportunistic screening (p < 0.05). POE adherence was higher with organized invitation plus community awareness (77.2%) than with home-visit support (58.1%). A total of 15 biopsies were performed within the organized screening groups, identifying 6 cases of oral potentially malignant disorders and 5 cases of OC. In contrast, biopsies conducted outside the screening program demonstrated significantly lower detection rates (p < 0.0001). These findings demonstrate that organized, invitation-based screening integrated into PHC can substantially expand access to early diagnosis among high-risk and socially vulnerable individuals who would otherwise remain unscreened, reinforcing PHC as a strategic and equitable setting for sustainable early OC detection.