Background: Oral squamous cell carcinoma (OSCC) represents most malignant neoplasms of the oral cavity and is strongly associated with modifiable risk factors, particularly tobacco and alcohol consumption. Early detection through screening initiatives is critical for improving prognosis; however, evidence regarding the most effective screening strategies for reaching high-risk populations remains limited, especially in real-world public health settings. Objective: To compare the effectiveness of an organized screening strategy and an active search approach in identifying high-risk individuals for oral cancer within a regional cancer prevention program in São Paulo State, Brazil. Methods: A cross-sectional study was conducted in 2022 using a mobile dental unit operating in 18 municipalities within the DRS-V region. A total of 3,505 individuals considered at high risk for oral cancer were screened through two different strategies: organized screening, based on scheduled appointments at primary healthcare units, and active search, involving field-based outreach in settings with a high concentration of at-risk individuals. Standardized clinical oral examinations were performed by trained dentists. Biopsies were carried out when lesions were clinically suspicious. Sociodemographic characteristics and clinical findings were analyzed using descriptive and inferential statistical methods. Results: Active search accounted for 63.3% of the screened participants and 75% of all biopsies performed, including most diagnoses of OSCC and oral potentially malignant disorders (OPMD). The active search strategy demonstrated greater effectiveness in engaging men and individuals with a history of tobacco and alcohol use, populations typically underrepresented in preventive health services. Conclusion: Within this regional screening program, the active search approach was nearly twice as effective as organized screening in reaching the target population and identifying early-stage lesions. These findings support the use of proactive, community-based screening models as a viable and equitable strategy for oral cancer prevention and early detection in underserved populations.
 

Oral clinical examinations based on active local screening