Oral Cancer Screening: A Biosocial Analysis of Global Barriers-A Narrative Review of Who Screens, Who Gets Screened, and Why

Background: Oral cavity cancer remains a major public health challenge because many cases are diagnosed at advanced stages, when treatment is more complex and outcomes are poorer. Although oral cancer screening involves a simple, non-invasive examination, its implementation remains inconsistent across settings. This review examines barriers to oral cancer screening through a biosocial lens, with attention being paid to clinical, social, and policy factors shaping access. Materials and Methods: This study was conducted as a structured narrative review of peer-reviewed literature and policy documents. Targeted searches of PubMed and Google Scholar were taken from database from 2000 to May 2024 using MeSH terms and free-text terms related to oral cancer screening, disparities, social determinants, access, guidelines, and policy. Eligible sources included English-language studies and guidance documents addressing oral cancer screening practices, barriers, disparities, or recommendations. Findings were synthesized thematically and interpreted using a biosocial framework informed by social medicine theory. Results: The review finds that oral cancer screening is limited by variation in guideline recommendations, uneven integration across healthcare settings, and persistent disparities in access among high-risk populations. Patients with the greatest burden of risk often face the greatest barriers to early detection because of structural disadvantage, fragmented service delivery, and weak policy support. The literature also suggests that narrow evidentiary standards and cost-effectiveness debates may limit the legitimacy and uptake of screening initiatives. Conclusions: This review does not propose a wholly new model of screening; rather, it offers a biosocial interpretation of existing evidence to explain why screening inequities persist. More equitable oral cancer screening will require not only clinical attention to high-risk populations but also reforms in guideline development, service organization, and health policy to better address structural barriers to access.