Public Awareness and Knowledge of Oral Cancer in 13 Middle Eastern and North African Countries
Authors: Mohammad Zakaria Nassani, Anas Alsalhani, Faisal Mehsen Alali, Samer Rastam, Nasser Raqe Alqhtani, Abdullah Saad Alqahtahni, Ali Robaian, Faisal S. Alhedyan, Abdullah Bin Nabhan, Adel Alenazi, Khalid Ayidh Alqahtani, Ali Alrafedah, Abdullah Ahmed Abbas Alleft, Banna Alnufaiy, Rafif Alshenaiber, Rawda Omar Alghabban, Maram Alagla, Mohammed A. S. Abuelqomsan, Maya Al-Joukhadar, Noujoud Al Zahed, Shorouk Darwish, Azza Sioufi, Enass Shamsy, Omar Kujan, Mohammed Noushad, Sadeq Ali Al-Maweri, Abdulaziz Binrayes, Basem Sabbagh, Bassel Tarakji
Journal: JAMA Network Open (2025)

Public awareness of oral cancer is crucial for prevention, early detection, and improved survival rates. Knowledge gaps in Middle Eastern and North African countries and areas for public education need to be assessed. To evaluate public knowledge and awareness of oral cancer, including risk factors, signs and symptoms, and protective measures, in Middle Eastern and North African countries. This cross-sectional study was conducted using an open, web-based questionnaire from January to December 2022 across 13 Middle Eastern and North African countries (Saudi Arabia, Syria, Egypt, Jordan, Lebanon, Iraq, Sudan, Morocco, Algeria, Yemen, the United Arab Emirates, Qatar, and Oman). Participants were recruited from the general adult population via social media platforms. Primary outcomes included knowledge of risk factors, signs and symptoms, and protective measures. Factors associated with good knowledge were evaluated based on age, sex, education level, country income level, smoking status, smokeless tobacco use, and exposure to dental education on oral cancer. Among 4197 participants (2243 aged 18-30 years [53.4%]; 2372 female [56.5%] and 1825 male [43.5%]), 1559 participants (37.2%) demonstrated good knowledge of oral cancer risk factors, 2028 participants (48.4%) were aware of its signs and symptoms, and 2478 participants (59.1%) recognized associated protective measures. Factors associated with good knowledge across all domains included university education (eg, risk factor knowledge: odds ratio [OR] vs ≤intermediate school, 1.52; 95% CI, 1.20-1.92), no tobacco use (eg, risk factor knowledge: OR for never smoking, 1.44; 95% CI, 1.20-1.74), and receiving education from a dentist (eg, risk factor knowledge: OR, 8.60; 95% CI, 7.33-10.08) at the P < .05 significance threshold. Being female (eg, 1491 females [62.9%] vs 987 males [54.1%] with good knowledge) and residing in upper-middle- or high- vs low- and lower-middle-income countries (eg, 1230 of 1891 participants [65.1%] vs 1248 of 2306 participants [54.2%] with good knowledge) were also associated with increased awareness of protective measures at the P < .00036 significance threshold with Bonferroni adjustment. This study found a significant lack of oral cancer awareness in Middle Eastern and North African populations, particularly among individuals with lower levels of education and those who used tobacco. Findings also underscore the critical role of dental professionals in improving public knowledge of oral cancer through targeted educational interventions.