Open Access Open Badges Research article

Perspectives of San Juan healthcare practitioners on the detection deficit in oral premalignant and early cancers in Puerto Rico: a qualitative research study

Douglas E Morse1*, Carmen M Vélez Vega2, Walter J Psoter14, Himilce Vélez3, Carmen J Buxó4, Linda S Baek1, Augusto Elias4 and Melba Sánchez Ayendez5

  • * Corresponding author: Douglas E Morse

  • † Equal contributors

Author Affiliations

1 Department of Epidemiology & Health Promotion, New York University College of Dentistry, 250 Park Avenue South, Room 633, MC: 9479, New York, NY, 10003-1402, USA

2 Department of Social Sciences, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, 00936, PR

3 Public Health Program, Ponce School of Medicine, Ponce, 00716, PR

4 Office of the Assistant Dean of Research (A141E), School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, GPO Box 365067, San Juan, 00936-5067 PR

5 Formerly, Department of Human Development, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR

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BMC Public Health 2011, 11:391  doi:10.1186/1471-2458-11-391

Published: 26 May 2011



In Puerto Rico, relative to the United States, a disparity exists in detecting oral precancers and early cancers. To identify factors leading to the deficit in early detection, we obtained the perspectives of San Juan healthcare practitioners whose practice could be involved in the detection of such oral lesions.


Key informant (KI) interviews were conducted with ten clinicians practicing in or around San Juan, Puerto Rico. We then triangulated our KI interview findings with other data sources, including recent literature on oral cancer detection from various geographic areas, current curricula at the University of Puerto Rico Schools of Medicine and Dental Medicine, as well as local health insurance regulations.


Key informant-identified factors that likely contribute to the detection deficit include: many practitioners are deficient in knowledge regarding oral cancer and precancer; oral cancer screening examinations are limited regarding which patients receive them and the elements included. In Puerto Rico, specialists generally perform oral biopsies, and patient referral can be delayed by various factors, including government-subsidized health insurance, often referred to as Reforma. Reforma-based issues include often inadequate clinician knowledge regarding Reforma requirements/provisions, diagnostic delays related to Reforma bureaucracy, and among primary physicians, a perceived financial disincentive in referring Reforma patients.


Addressing these issues may be useful in reducing the deficit in detecting oral precancers and early oral cancer in Puerto Rico.