Barriers to early diagnosis and treatment of oral cancer in countries in Africa: a scoping review.

BACKGROUND: In Africa, the high mortality associated with oral cancer is driven by multiple factors. This ScR aims to map the existing evidence on the barriers to early diagnosis and treatment of oral cancer in Africa. METHODS: A search was run between October and November 2024 in four electronic databases: Web of Science, PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL). A combination of the terms of the context was employed, which included the 54 African countries, and the concept, including a range of terms for oral cancer. Qualitative and quantitative primary studies were included, with eligibility determined by title and abstract screening followed by full-text screening. The data extracted were analysed using a thematic synthesis approach, and the themes were derived from the Socio-Ecological Model. RESULTS: Eight studies met the eligibility criteria. The studies were hospital-based, descriptive cross-sectional studies conducted in six countries in East, West, and Southern Africa between 1999 and 2024. Common barriers to both early diagnosis and treatment of oral cancer include reliance on traditional medicine, lack of awareness about oral cancer symptoms, financial constraints, and the inability to forego daily income. At the organizational level, shared barriers include inefficient referral systems, long waiting times, and inadequate healthcare infrastructure. Unique factors for barriers to early diagnosis include rural residence, self-medication behaviours, low education levels, lack of public awareness, inadequate dentist training, frequent misdiagnoses, and poverty. In contrast, unique barriers to treatment involve negligence, fear of treatment, challenges in obtaining work leave, delays in clinical action, geographic challenges, long waits for histopathology results, and shortages of medications, beds, and functional equipment. Regional variations in barriers to early oral cancer diagnosis and treatment in Africa were observed, including gender related issues in West Africa. CONCLUSIONS: There are multiple-level barriers to the early diagnosis and treatment of oral cancer in countries in Africa. Addressing these barriers requires the combined efforts of multiple stakeholders and interventions tailored to regional needs to improve oral cancer outcomes and foster equitable healthcare access. Gender sensitive approaches to address caregiving burdens in Senegal are vital. Crucially, evidence is limited, so more studies must be conducted, especially in Northern and Central Africa, to address these barriers. Longitudinal and mixed-methods studies are also recommended to better understand how those barriers evolve.