Experiencing oral cancer: what poor Brazilians believe and dentists should know

ABSTRACT

Introduction: Early detection, treatment and referral of oral cancer are critical for effective control. Yet, in impoverished Northeast Brazil, myriad social determinants retard early detection, contributing to high disease rates. Methods: To improve early diagnosis, this qualitative, anthropological study explores the significance of oral cancer for poor, low-literacy Brazilian patients. During six months in 2004-2005, ethnographic interviews and narratives about diseases were done with 25 patients diagnosed with squamous cell carcinomas at three medical institutions in Fortaleza, Ceara. Results/Discussion: Findings show that patients unanimously failed to practice government-promoted, self-examination to detect oral lesions in incipient stages. Delays of 9.5 months, on average, were reported from first consultation with health professionals to receiving a diagnosis of oral cancer. Treatment delays and resistance, it is argued, are due more to conceptual differences between lay and professional Explanatory Models and constraints imposed on lives in poverty than to patients´ lack of interest or motivation to self-care. Patients diagnose early mucosal alterations, avoid perceived “risky” behaviors -- differing radically from biomedicine´s --self-treat with home remedies and seek popular healers early-on to relieve pain. Popular perceptions of health professionals as “ignorant, brutal baptized horses” and resistance to care, probably contribute to delays. Conclusions: Empowering patients for self-care and forging a partnership between health professionals —including dentists -- and traditional healers (in Portuguese rezadeiras, práticos, protéticos) can conceivably reduce oral cancer disease burden, improve dental care quality and reduce human suffering in this context.