Oral Cancer Disparities in Low- and Middle-Income Countries: A Global Health Equity Perspective on Prevention, Early Detection, and Treatment Access.

Background: Oral cancer represents a critical global health equity challenge, with over 80% of cases occurring in low- and middle-income countries (LMICs) and markedly lower survival rates in these regions compared to high-income countries (HICs). Objective: To examine oral cancer disparities in LMICs through a global health equity lens by analyzing prevention strategies, early detection programs, and treatment access barriers, with the aim of identifying evidence-based interventions to reduce these inequities. Methods: This comprehensive narrative review synthesized evidence from peer-reviewed literature (2020-2025), including systematic reviews and reports from international health organizations. We searched PubMed, Web of Science, and Scopus using terms related to oral cancer, global health disparities, LMICs, prevention, screening, and treatment access. Results: Oral cancer demonstrates profound global disparities. LMICs bear ~82% of the global disease burden yet achieve five-year survival rates of only 25-45%, compared to 65-85% in HICs. Key contributing disparities include the following: tobacco use remains high (LMICs account for 1.3 billion tobacco users) due to weak control programs. Limited human papillomavirus vaccination coverage is under 50% in most LMICs (vs. ~70-85% in HICs), and 70% of LMICs have no systematic oral cancer screening. In addition, 60-80% of oral cancer cases in LMICs present at advanced stages (vs. ~40-60% in HICs). They have severely limited access to surgery, radiotherapy, and chemotherapy (roughly 1 available service for every 5-10 needed). Conclusions: Addressing oral cancer disparities in LMICs requires comprehensive strategies, including strengthened tobacco control, cost-effective screening programs using innovative technologies, task shifting to expand the health-care workforce, and international partnerships to improve treatment infrastructure in resource-poor settings. These combined efforts are essential to close the outcome gap and achieve global health equity in oral cancer care.