Cancer is the second leading cause of death in the Western Pacific region. The prevalent tradition of chewing betel nut in Palau, an island nation in this region, is a risk factor in the development of oral cancer. Oral cancer is the fifth most common cancer in Palau, and prognosis can be improved with early detection. The purpose of this study is to assess the feasibility of oral cancer screening using existing dental health infrastructure in Palau.

A mixed methods approach was used to explore topics related to dental health and use of these resources in Palau. Quantitative measures of dental health utilization and qualitative assessment of barriers and facilitators to accessing dental care were the primary measures of this study. Knowledge, attitudes, and beliefs about betel nut use and oral cancer were secondary measures of this study. Open-ended survey questions were coded to develop emergent themes based in grounded theory. These themes are interpreted in the context of the Three Delays model.

There was a total of 223 completed surveys. Mean age was 43.7 years, 80% identified as female, and most (94.3%) reported ever having seen a dentist in Palau. Dental care was seen as important (mean score 82.3), and 57.9% reported it was easy to see a dentist. Themes regarding barriers to dental care addressed cost and availability of dentists/appointments. Themes regarding facilitators included multilevel resources and transportation. Approximately half of respondents were current users of betel nut, and the majority of these (64.1%) were daily users. Results suggest there are facilitators in place to promote seeking and obtaining dental care, however, existing infrastructure may not support an oral cancer screening program. These data provide important areas to address that can improve access and support the implementation of oral cancer screening through existing dental care in the future.

Informed consent was obtained (written). The survey was made available through Facebook Ads. Responses were stored in REDCap and analyzed using Excel and SPSS. Open-ended responses were open-coded by two of the authors and themes were generated using grounded theory. 

Microsoft Excel