Community and health system challenges in oral cancer screening in India: a systematic review

Oral cancer remains a major public health concern in India, accounting for a significant proportion of cancer-related morbidity and mortality. Early detection through screening is considered an effective strategy for reducing disease burden and improving survival outcomes. Both community members and healthcare workers play an essential role in oral cancer screening programs; however, several barriers may affect the implementation and effectiveness of these screening initiatives. Understanding these factors is important for strengthening screening services and improving early detection efforts. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was retrospectively registered in PROSPERO (CRD420261422293). PubMed and Scopus were systematically searched for primary studies published in English from 01 January 2010 to 31 May 2026. Studies involving community members (adults aged 18 years and above) or healthcare workers that addressed barriers to oral cancer screening in India were included. Two reviewers independently screened the studies for eligibility. Data extraction was performed by one reviewer and independently cross-checked for accuracy by a second reviewer. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018. A narrative synthesis of findings was performed. Eleven studies met the inclusion criteria, encompassing cross-sectional, qualitative, mixed methods, and quasi-experimental designs across multiple Indian states and union territories. Barriers were identified across community, healthcare worker, and health system levels using the WHO Health System Building Blocks framework and Three domains of the Social-Ecological Model: intrapersonal, interpersonal, and community. The principal barriers included limited knowledge and awareness, psychological and sociocultural constraints, household economic barriers, inadequate workforce capacity and training, fragmented referral pathways, weak health information systems, technological and infrastructure limitations, financial barriers, and governance constraints. Oral cancer screening in India is impeded by multilayered, interconnected barriers that cannot be addressed through awareness campaigns alone. Integration of screening into Ayushman Bharat Health and Wellness Centres, structured capacity building for community health officers and ASHA workers, and concurrent demand-side interventions targeting stigma, economic hardship, and gender-based access constraints are essential. Sustained policy commitment and equity-focused programme design are urgently needed to reduce India's preventable oral cancer mortality. Registration ID: PROSPERO (CRD420261422293).