prevalence and determinants of oral premalignant and malignant lesions in rural konkan, india: a retrospective cross-sectional study from a preventive oncology outpatient department

Background: preventive oncology outpatient departments (opds) have emerged as a pragmatic approach to improving early cancer detection in underserved rural india. however, data from the konkan region remain limited. objectives: this study estimated the prevalence of oral abnormalities and associated risk factors using methods for rare outcomes, including firth's penalized logistic regression and fdr correction.methods: we conducted a retrospective cross-sectional analysis of 7,435 individuals screened at a preventive oncology opd in rural konkan between january 2024 and june 2025. descriptive statistics summarized participant characteristics. group comparisons used chi-square tests with fdr-adjusted p-values. the primary outcome was premalignant or malignant oral lesions (n = 41); benign lesions were descriptive only. firth's penalized logistic regression addressed small-event bias. model performance used calibration metrics and bootstrap validation (1,000 iterations). sensitivity analyses were exploratory and hypothesis-generating.results: the prevalence of any abnormal oral finding was 0.73% (95% ci: 0.55–0.95). premalignant lesions were identified in 0.36% (27/7,435) and malignant lesions in 0.19% (14/7,435), yielding a combined prevalence of 0.55% (41/7,435). smokeless tobacco use was reported by 17.3%, with gutka most common (50%). gutka users had higher lesion prevalence than other forms (3.1% vs. 1.7%), with an unadjusted or of ~1.9. in penalized models, smokeless tobacco use (aor 3.45), poor oral hygiene (aor 2.89), and age ≥50 (aor 2.83) were significant. nns was 182 (95% ci: 135–244).conclusion: this study identifies smokeless tobacco use and poor oral hygiene as key correlates of oral premalignant and malignant lesions in a rural konkan population. findings are associative given the cross-sectional design, limited events, and potential residual confounding. penalized regression and multiple-testing correction strengthen analysis, though limitations remain. preventive oncology opds may support early detection, pending prospective, adequately powered external validation.