Self-Examination of The Oral Cavity as A Strategy for Awareness and Help-Seeking Behavior in Oral Cancer: Implications for The Betel Quid Chewing Community in Papua
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Oral cancer remains a major public health concern, particularly among populations exposed to tobacco, alcohol, smokeless tobacco products, and areca nut. Mouth self-examination (MSE) is a simple approach that enables individuals to recognize oral abnormalities; however, its effectiveness as a stand-alone screening method remains uncertain. This review aimed to synthesize evidence on MSE for the early detection of oral cancer and oral potentially malignant disorders (OPMDs), distinguish its diagnostic performance from its potential to improve awareness and help-seeking behavior, and assess its relevance to betel quid-chewing communities in Papua, Indonesia. A structured narrative literature review was conducted using PubMed/MEDLINE and authoritative scientific sources. Systematic reviews, meta-analyses, randomized controlled trials, diagnostic accuracy studies, Indonesian epidemiological studies, and recommendations from the International Agency for Research on Cancer (IARC) were prioritized. Evidence was synthesized across diagnostic performance, awareness and behavioral outcomes, professional oral examination, and areca nut exposure. Diagnostic studies reported low and variable MSE sensitivity, ranging from 8.6% to 43%, with one study reporting 0% sensitivity for OPMDs in a high-risk Indigenous population. In contrast, educational interventions incorporating MSE improved knowledge, awareness, self-efficacy, intentions, and self-examination practices. Professional oral examination demonstrated better diagnostic performance, with pooled sensitivity and specificity estimates of approximately 71% and 85%, respectively. Indonesian evidence indicated a substantial burden of OPMDs and strong associations with betel quid exposure, including findings from West Papua. Therefore, MSE should not be recommended as a stand-alone screening method but may serve as a complementary strategy for improving oral health literacy and encouraging timely help-seeking behavior. In Papua, oral self-examination initiatives, including SAMURI, could be culturally adapted and integrated with risk-factor education, professional oral examinations, and accessible referral pathways.
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Copyright (c) 2026 Erick Werner Nickolay Akwan, Alva Samantha Lipas Djitmau , Nikanor Kaladius Reumi Wonatorey , Tommy Jack Numberi , Samdei Carolina Rumbino
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