Accuracy of screening oral pre-malignant and malignant lesions in primary care

Since 1990, Brazil has undergone considerable health reform under the principles of universal coverage and health as a right of all citizens, with an emphasis on decentralisation, equity, services integration and community participation. The process has advanced rapidly within the realm of primary health care. Oral cancer is responsible for a number of deaths in Brazil and screening techniques in primary health care programmes can be used to identify people who are most susceptible to the disease. Objective. To analyze the accurary of screening for oral lesions by visual inspection in primary health care. The reference population was composed of 15,072 residents of 50 years old or older of both genders listed in seven units of family health (USF) in São Paulo City, managed by Casa de Saude Santa Marcelina. Secondary data from the information system related to 2,980 individuals composed study population. During screening in social institutions, soft tissues of the individuals’ oral cavity were examined by trained dentists and distributed into two categories: (0) soft tissues apparently healthy, (1) alterations in soft tissues. All positive and negative tested subjects were undergone to comprehensive clinical exams. Individual records were grouped in an electronic basis. Point and confidence interval estimates (95%) were calculated, regarding measures of sensitivity (SE), specificity (SP), and positive predictive value (PPV). Results showed that 18.0% of the screened population was considered test positive. A total of 133 lesions (4.5%) were identified during clinical examination, and 8 cases of oral cancer were confirmed, which corresponds to a prevalence rate of 27 cases in 10,000 people, a much higher rate than the expected. The measures found were: SE: 91.7% [90.7-92.7], SP: 85.4% [84.1-86.6], PPV: 22.7% [21.2-24.2]. Delegation of this function to community health agent and risk groups focus are discussed for improve PPV and coverage