|
Evidence of Benefit
The routine examination of asymptomatic and symptomatic patients can lead to
detection of earlier stage cancers and premalignant lesions. There is
no definitive evidence, however, to show that this screening can reduce
mortality.[1,2]
In Sri Lanka and India, three large studies of screening for oral cancer (involving
more than 250,000 patients) have shown that it is possible for primary health care
workers to detect premalignant lesions and early cancers in these populations
at high risk due to habits of tobacco and betel nut chewing and reverse smoking
(placing the lit end of the cigarette in the mouth).[3-5] The general results
of these studies were as follows: (1) 12% to 26% of screened participants had
oral lesions that did not require referral to a specialist; (2) 1.3% to 4.2% of
screened patients had referable oral mucosal lesions, and of these, 45% to 80%
were correctly referred; (3) the false-positive rate ranged from 9% to 29%; and
(4) primary health care workers detected a total of 44 new oral cancers.
Compliance rates of these studies varied from 54% to 72%, and poor compliance
following initial screening make feasibility of these types of studies
uncertain. Health education programs only marginally increased compliance
rates. Compliance problems of the Indian and Sri Lankan studies are likewise a
possibility in the United States and other countries, which also have
experienced suboptimal compliance among high-risk tobacco and alcohol users.[6]
Contradictory oral cancer screening recommendations have been issued by the
U.S. Preventive Health Services Task Force (against) and the American Dental
Association (for).[1] Oral
exfoliative cytology is the most extensively studied screening procedure of
U.S. oral screening programs. Problems encountered with this screening method
include a high proportion of false-negative examinations and poor voluntary
participation by the highest-risk individuals (heavy tobacco and alcohol
users).
New screening techniques using brush biopsy have been developed. Despite limitations, these techniques have improved the sensitivity (92.3%) (95% CI, 74.9–99.9%) and specificity (94.3%) (95% CI, 86.0–98.4%) for detection of oral squamous cell carcinoma or dysplasia when tested on visually identified lesions.[7,8]
References
-
Screening for oral cancer. In: Fisher M, Eckhart C, eds.: Guide to Clinical Preventive Services: an Assessment of the Effectiveness of 169 Interventions. Report of the U.S. Preventive Services Task Force. Baltimore, Md: Williams & Wilkins, 1989, pp 91-94.
-
Antunes JL, Biazevic MG, de Araujo ME, et al.: Trends and spatial distribution of oral cancer mortality in São Paulo, Brazil, 1980-1998. Oral Oncol 37 (4): 345-50, 2001.
[PUBMED Abstract]
-
Warnakulasuriya KA, Nanayakkara BG: Reproducibility of an oral cancer and precancer detection program using a primary health care model in Sri Lanka. Cancer Detect Prev 15 (5): 331-4, 1991.
[PUBMED Abstract]
-
Mehta FS, Gupta PC, Bhonsle RB, et al.: Detection of oral cancer using basic health workers in an area of high oral cancer incidence in India. Cancer Detect Prev 9 (3-4): 219-25, 1986.
[PUBMED Abstract]
-
Warnakulasuriya KA, Ekanayake AN, Sivayoham S, et al.: Utilization of primary health care workers for early detection of oral cancer and precancer cases in Sri Lanka. Bull World Health Organ 62 (2): 243-50, 1984.
[PUBMED Abstract]
-
Prout MN, Sidari JN, Witzburg RA, et al.: Head and neck cancer screening among 4611 tobacco users older than forty years. Otolaryngol Head Neck Surg 116 (2): 201-8, 1997.
[PUBMED Abstract]
-
Sciubba JJ: Improving detection of precancerous and cancerous oral lesions. Computer-assisted analysis of the oral brush biopsy. U.S. Collaborative OralCDx Study Group. J Am Dent Assoc 130 (10): 1445-57, 1999.
[PUBMED Abstract]
-
Scheifele C, Schmidt-Westhausen AM, Dietrich T, et al.: The sensitivity and specificity of the OralCDx technique: evaluation of 103 cases. Oral Oncol 40 (8): 824-8, 2004.
[PUBMED Abstract]
Back to Top
< Previous Section | Next Section > |
