Strengthening Collaborations in Latin America for Advancing Oral cancer research and public health policies

TL;DR

This review highlights the need for stronger regional collaborations in Latin America to improve oral cancer research and public health policies.

Contribution

The paper identifies gaps in oral cancer research and emphasizes the potential of collaborative networks to address regional challenges.

Findings

Most studies on oral cancer in Latin America focus on OC itself, with limited research on potentially malignant disorders.

Collaborative studies have increased, focusing on regional risk factors like tobacco and alcohol use.

Challenges include limited epidemiological data and inadequate public health infrastructure.

Abstract

Oral cancer (OC) represents a significant public health challenge in Latin America, with similar challenges presented in most countries of the region. Regional partnerships are needed, as they can enhance the development of educational campaigns, prevention strategies addressing shared risk factors, and institutional strengthening. Additionally, expanding collaborations can attract international funding and integrate LAC researchers into global initiatives.

This review examines the state of OC research in the region, highlighting collaborative efforts, gaps, and opportunities for advancement.

We identified 17 studies that have studied different aspects of oral cancer in Latin American countries (LAC). Studies varied in design, with ecological studies and case series being the most common. Most studies focused purely on OC, while research on oral potentially malignant disorders (OPMD) remains limited. Collaborative studies have increased over the past decade, with a growing focus on regional risk factors such as tobacco and alcohol use. Despite these advances, challenges persist, including limited epidemiological data, underreporting of cases, and inadequate public health infrastructure.

Collaborative networks have the potential to reduce these gaps by pooling resources, expertise, and data. Improved public health policies supported by robust local data are crucial for reducing the OC burden in LAC. Strengthening regional and international collaborations will be fundamental for the advancement of OC research, improving early detection, and implementing effective prevention and treatment strategies tailored to the region’s unique challenges.

Key words:Oral cancer, mouth neoplasms, Latin America, oral potentially malignant disorders.

Full text

Introduction

In recent years, there has been a significant increase in collaborations between Latin American countries (LAC) in research, especially on oral cancer (1). This movement has been crucial for scientific advancement and the development of regional strategies to combat the disease. The socio-economic and cultural similarities among Latin American countries provide a common foundation that facilitates the creation of research protocols and the implementation of public policies specific to the needs of the region. However, despite this progress, expanding these collaborations even further is essential to address the remaining gaps in research and improve public health outcomes.

The aim of this paper was to perform a review of the situation of oral cancer research in LAC, by identifying studies that have been done in this area.

Material and Methods

To identify studies related to oral cancer (OC) and/or oral potentially malignant disorders (OPMD) focusing on the Latin-american region, we used the terms ((latin america) AND (oral cancer)) OR (oral precancer) OR (oral potentially malignant disorder). A manual search was also performed. Inclusion criteria were review articles, position papers, observational studies, systematic reviews, case series related to any type of oral cavity cancer in Latin America. Studies of head and neck cancer were included only when specifying that cases of OC were part of the cohort. There was no time limit. Exclusion criteria were case reports, and Latin-American studies about cancers of anatomical regions different than the oral cavity.

Results

The search identified a total of 956 studies, 10 of which were duplicates. The records were filtered by title and abstract, and 916 articles were eliminated as were not related to the topic. Finally, 30 articles were fully reviewed, and 17 were included (Table 1).

Of the 17 records, 14 had representation of more than 2 different countries (range 1 to 23) with an average of 4,9 countries per record. Brazil was the country with the highest number of participations, being involved in 16 of the 17 articles, followed by Colombia (n= 7), Mexico (n= 7), Argentina (n =6), Perú (n= 6) and Chile (n= 5). All other countries were involved in 3 or less articles. According to the year of publication, 2 studies were published between 2001-2008, 6 between 2010-2019, and 8 between 2020-2024. Twelve studies declared to study oral cancer but only one specified to be OSCC, and in 2 studies oral cancer was included in as a subset of a HNSCC cohort. There were only 4 studies that focused on OPMD; 1 was a systematic review, 1 was survey, 1 assessed the frequency of OSCC associated with OPMD, and 1 a case series of HPV-OED. Apart from that last paper, none of the others specified which OPMD was studied. There was 1 study about primary oral melanoma and 1 case series of malignant odontogenic tumors. The most common study design was Ecological study (n= 3) and case series (n= 3), followed by review articles (n= 2), case-control studies (n= 2) and Cross-sectional studies (n= 2). We identified no clinical trials (Table 1).

Discussion

The incidence of cancer in LAC is high and projected to increase, being one of the most frequent causes of death for most countries (2,3). Although there is a significant variability in cancer burden in LAC, similar challenges are present in most countries such as socioeconomic conditions and access to therapies (3)

LAC economies are growing rapidly, leading aging of the population and an increase in lifestyles unhealthy patterns. Implementation of control policies of risk factors for oral cancer, such as tobacco and alcohol, have proven to have an effect on oral cancer mortality, showing the need for more studies that can improve preventive measures.

In most of LAC, the main risk factors causing diseases are tobacco, alcohol consumption and high rate of body mass. Tobacco is one of the main risk factors for death and disability, contributing to poverty and exerting an enormous economic burden on health systems. Smoking is responsible for 351,000 deaths per year in LAC, causing $22.8 billion in direct medical costs,$16.2 billion in lost productivity, and $10.8 billion in caregiver costs (4). There are currently 22 countries of the region that are implementing measures to advise about the dangers of tobacco use through graphic health warnings on packaging of tobacco products. In Brazil, starting in 1996, there was a progressive restriction on cigarette advertising and the adoption of significant control measures. In 2019, Uruguay enacted policies that now require plain packaging of tobacco products. Antigua and Barbuda (2018), Venezuela (2019) and Mexico (2021) have prohibited advertising, promotion and sponsorship of tobacco products (5). Despite all this, only 10 countries have surveillance systems that provide recent, periodic and representative data on tobacco consumption in adults and youth. Additionally, there is no data on secondhand smoke exposure, making it difficult to accurately assess the impact of smoke-free policies. There remains a gap in expanding access to tobacco cessation services, such as helplines, medications and behavioral therapies (4).

LAC continues to face significant challenges in oral cancer research, especially regarding epidemiological data. The region lacks comprehensive national registries and large-scale studies are needed, making it difficult to assess the true incidence and prevalence of the disease (6). We identified only 3 large-scale ecological studies (2,7,8). The underreporting of oral cancer cases in LAC limits the ability to develop precise public health and may prevent the achievement of the primary prevention goals (9). An important effort to improve prevention and information in the region is the Latin American and Caribbean Code against Cancer Framework, a collaboration of the Pan American Health Organization (PAHO) and the International Agency for Research on Cancer (IARC), that gather information from LAC and aims to reduce the burden of cancer in the region (https://cancer-code-lac.iarc.who.int/es/).

Collaborative efforts across countries can help fill these gaps by pooling data, resources, and expertise, which will lead to more effective, localized health interventions. Additionally, many LAC share common risk factors for oral cancer, such as high rates of tobacco use, alcohol consumption, poor access to preventive dental care, and socioeconomic aspects. By improving collaborative research efforts, countries in the region can design more targeted prevention strategies aimed at addressing these shared risk factors. This will not only lead to more effective interventions but will also help public health policies in the region.

Brazil is by far the country that has contributed the most in oral cancer research in Latin America. Brazilian researchers were involved in 16 of 17 identified studies. In addition to being the largest country in the region with the highest population, several factors also contribute to the prominence in research, such as the high incidence of the disease, a well-established network of scientific research centers that has been enhanced over the years with public funding, and the Unified Health System (SUS), one of the world’s largest public healthcare systems, which provides robust epidemiological data. This strong presence in research highlights Brazil’s important role in fostering integration and collaboration among other Latin American countries.

The lack of public health literacy, particularly regarding the early symptoms and risk factors of oral cancer, is an important challenge for its prevention and diagnosis. Strengthening collaborative networks can help the development of educational campaigns designed to enhance health literacy and awareness among both the general population and healthcare professionals, while addressing the linguistic and cultural diversity within the region. (10). Many countries in the region face a shortage of healthcare professionals trained in the diagnosis and treatment of oral cancer (6). Through collaborative networks, joint training programs, workshops, and academic partnerships can support the training and capacity-building of healthcare professionals, equipping them to be better prepared for addressing the challenges posed by the disease. This will ensure a more prepared workforce to address the rising cases of oral cancer and improve the quality and reliability of data and studies emerging from the region (10).

Discussions on oral potentially malignant factors (OPMD) and its management also seems to be barrier for early diagnosis, and regional risk factors must also be taken into account for screening (6,11). We identified only 4 collaborative studies on OPMD, which is probably a reflection of the lack of registries regarding this topic in LAC. It seems that the new generations of oral pathologists and oral medicine specialists of the region are conscient of this issue, as all 4 articles available were published between 2023- and 2024. Nevertheless, there is a lack of data regarding the types, frequency, regional risk factors, and malignant transformation rate of OPMD in the region.

Access to funding and resources is another critical factor. Besides socioeconomic factors, economical investments also influence the mortality rate of cancer in LAC (12).Thus, international collaborations can help attract funding from global health organizations, foundations, and governments to support research design for the specific needs of the region. Presenting a united front and demonstrating the potential for regional impact increases the chances of financial support. Moreover, expanding intra-regional collaborations would also facilitate Latin America’s integration into global research networks. By participating in international initiatives and conferences, such as the World Workshop on Oral Medicine, Latin American researchers can share knowledge with experts from around the world and ensure that the region’s unique challenges are included in global discussions about cancer prevention and treatment. Importantly, the results from collaborative regional research can serve as a strong foundation for advocating public health policies. Local data and evidence generated through collaborative studies will enable policymakers to implement more effective, evidence-based strategies for the prevention, early diagnosis, and treatment of oral cancer. It also ensures that best practices are shared and applied across borders, strengthening public health responses throughout the region.

Finally, these collaborative efforts will contribute to reducing healthcare disparities in the region. By focusing on underserved populations, such as those in rural areas or with limited economic resources, regional collaborations can promote more equitable access to care, ensuring that advancements in research and public health interventions benefit all segments of the population. Therefore, strengthening collaborations between Latin American countries is essential for advancing oral cancer research and improving public health outcomes in the region. Collaborations in the region have significantly increased during the last decade, but more efforts have to be done. By expanding these partnerships, countries can address gaps in data, improve capacity, secure funding, and ultimately reduce the burden of oral cancer, leading to improved quality of life and reduced health disparities throughout Latin America.