Abstract
BACKGROUND/PURPOSE: South Asia has a high burden of oral cancer (OC); however, delays in diagnosis remain under-researched. The study investigated delay intervals in OC diagnosis and the contributing factors in rural Pakistan, considering its unique sociocultural context. MATERIALS AND METHODS: This multi-center cross-sectional study employed a structured questionnaire to interview 152 oral squamous cell carcinoma (OSCC) patients. The diagnostic intervals were determined using the Aarhus Statement. Logistic regression assessed the association between independent factors and delay types. RESULTS: Patient delays occurred in 76.3 % of cases, mostly due to appraisal delays (65 %), while diagnostic delays appeared in 51.3 %. Median durations for patient, diagnostic, and total delays were 3, 1, and over 4 months, respectively. Appraisal delay was associated with infrequent dental visits (adjusted odds ratio [AOR]: 11.04, confidence interval [CI]: 2.29-81.53), advanced stage OSCC (AOR: 5.42, CI: 2.35-13.03), and rural residence (AOR: 3.99, CI: 1.75-9.35). Help-seeking delay was linked to use of home remedies (AOR: 5.74, CI: 2.35-14.46) and homeopathy (AOR: 4.72, CI: 1.90-11.91). Patient delay associated with advanced stage OSCC (AOR: 7.73, CI: 3.28-19.12) and rural residence (AOR: 3.91, CI: 1.62-9.69). Diagnostic delay was influenced by patients' lack of OC knowledge (AOR: 7.33, CI: 1.30-51.74), more than two visits before biopsy (AOR: 52.88, CI: 1.50-270.88), and initial treatment with analgesics (AOR: 13.37, CI: 3.68-60.99) or antimicrobials (AOR: 3.95, CI: 1.06-18.23). CONCLUSION: Delays in OC diagnosis arise from inadequate patient awareness, rural residence, traditional and complementary medicine use, and health system challenges. Improving healthcare access and public awareness are crucial.