研究背景：依據我國2020年癌症登記年報數據顯示，口腔癌為台灣十大癌症發生率第六名，男性第三名。由於口腔癌治療複雜，5年存活率低至40%。如果在癌症早期診斷，存活率可超過 80%。有鑑於此，政府於2010年開始大規模推動公費口腔黏膜篩檢，期望透過早期診斷的方式降低口腔癌死亡率。然而10餘年來公費篩檢服務量、篩檢對象、篩檢服務提供的情形與改變趨勢未曾受到討論，篩檢服務量與癌症發生情形也較缺乏研究分析。因此有探討台灣公費口腔黏膜檢查變動趨勢與影響之重要性。
研究目的：為探討台灣公費口腔黏膜篩檢變動趨勢與影響，本研究目的有三個：首先，探討口腔癌篩檢量變化趨勢、影響因素及對口腔癌防治的衝擊。其次，了解第一階段異常進行陽性追蹤的影響因子。最後，分析癌前病變者進行治療與否的影響因子。
研究方法：本研究採橫斷性研究設計，分成兩大部分，第一部分採用口腔癌篩檢檔篩選出自2010至2020年間參與口腔癌篩檢之30歲以上者，依據篩檢檔資料判定口腔癌篩檢量、篩檢人口、菸檳行為及篩檢服務提供，並以次數、百分比、連結點分析探討變動情形，再依據癌症登記檔長表篩選出30歲以上新發口腔癌個案，取得診斷期別與人數後，串聯前述口腔癌篩檢資料，將篩檢量變動與診斷前2年篩檢比例、新發個案早期比例，以相關係數探討其相關性。在陽性追蹤及癌前病變的治療選擇因子以邏輯式迴歸分析，將篩檢人口、菸檳行為及篩檢服務提供做為變項，探討兩者選擇因子是否存在特定分布。
研究結果：本研究共收錄10,395,088人次口腔癌公費篩檢者，以及55,546位新發口腔癌個案，作為研究樣本進行篩檢量的相關探討。研究主要結果顯示，自2010年推動公費口腔黏膜篩檢以來，總篩檢量在2012年達到高峰，隨後逐年下降，2020年篩檢量較2010年下降了48.96%。平均每年篩檢量變化率為-6.5%。並發現各年篩檢量與該年口腔癌新發個案前兩年有篩檢比例呈現高度正相關，而與晚期診斷比例呈現高度負相關。表示隨著篩檢量的減少，新發口腔癌患者中未篩檢比例上升，晚期診斷比例增加。而在篩檢的變動當中，吸菸相較嚼檳者的占比有上升趨勢，篩檢主要醫師為非牙科、非耳鼻喉科的其他科醫師。陽性追蹤方面，嚴重度高的癌前病變，例如疣狀增生、紅斑等陽追率僅約5成，陽追與否之選擇因素受到篩檢地點、篩檢醫師等因素影響。治療方面，嚴重度最高的疣狀增生為治療率最高，但仍僅有23.8%。
結論：透過本研究結果得知篩檢量的下降確實會導致晚期癌症比例的上升，且為高度相關，此發現凸顯篩檢對於口腔癌預防的重要性。並從篩檢人口、菸檳行為及服務提供的變化能令政府部門延伸探討篩檢量下降的原因。陽性追蹤與治療率低可能使篩檢效益下降，已發現癌前病變之癌症高危險群並無被密切追蹤，無法提早發現癌症，缺乏治療亦無法延後或阻斷癌前病變轉為癌症。本研究所採用之篩檢量變動分析策略，彌補本研究領域知識缺口，未來可作為中央政府實行篩檢相關政策的可靠證據。

In Taiwan, oral cancer ranks as the sixth most common cancer, with a five-year survival rate below 40%, though early diagnosis can increase it to 80%. Since 2010, the government has implemented oral mucosal screenings to reduce mortality, but trends and outcomes of these screenings have not been fully explored. This study analyzed data from over 10 million screenings and 55,000 new cases of oral cancer. Results show that screening participation peaked in 2012 but dropped nearly 49% by 2020, leading to more late-stage diagnoses. Follow-up rates for severe cases were low, with only 50% receiving monitoring and a 23.8% treatment rate for the most serious conditions. The findings stress the importance of maintaining screening efforts to prevent late-stage diagnoses and improve early cancer detection.

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