13
Volume1 Issue2
|
N
ews and
E
vents
Detection and Prevention of Oral Cancer:
ARESCREENINGMETHODS
EFFECTIVE?
CatherinePoh
Dr. Pohwasaco-author
of a
JCDA
article that includes
step-by-stepadviceon
performingaheadand
n
to screen
Diagnostic delays mean that more than half
of all people with oral and pharyngeal can-
cer have regional or distantmetastases at the
timeofdiagnosis.
1
Three reviews examined the latest evidence
on the effectiveness of screening programs
fororal cancer andarrivedatgenerally similar
conclusions: there isn’t enough evidence to
definitively say whether oral cancer screen-
ing is effective or not. The take-home advice
for dentists? Despite inconclusive evidence,
dentists should remain vigilant for signs of
precancerous or cancerous le-
sions in all patients while per-
forming routine follow-upand
newpatientoralexaminations.
“Dentists should use the op-
portunity of a routine oral ex-
amination to screen for oral
cancer,” says Dr. Catherine
Poh, associate professor in
the UBC faculty of dentistry
and researcher in the areas
of community screening and
management of high risk oral
precancerous lesions. “Soft
tissue screening is our responsibility as
dentists—ithas thepotential todetect
a variety of irregularities, including
early signsofmouthor throat cancer.
Threeminutes could savea life!”
CochraneCollaboration
A Cochrane review
2
assessed cur-
rent screening methods—visual
examination and adjunctive tech-
nologies like toluidine blue, fluores-
cencevisualizationor brushbiopsy—
and found no evidence of their effectiveness
in reducing mortality from oral cancer. The
authors found some evidence that a visual
examination reduces the death rate for oral
cancer in high-risk individuals—those who
used tobacco or alcohol or both—although
theevidencecame fromonlyone study.
Another Cochrane review
3
attempted to eval-
uate the diagnostic accuracy of an oral cancer
screening examination and other adjunctive
technologies, but the substantial variability in
the includedstudiesmade itdifficulttocompare
studiesorconductapooledanalysisof thedata.
U.S.PreventiveServicesTaskForce
A review by the U.S. Preventive Services Task
Force (USPSTF)
4
found there was inade-
quate evidence that the oral screening ex-
amination—visual examination and palpa-
tion—performed by primary care providers
accurately detects oral cancer or results in
improved morbidity or mortality through
treatment. However, the USPSTF statement
clearlynotes that its recommendationonoral
cancer screeningdoes not pertain todentists
orotolaryngologists.
Although tobaccoandalcohol useareconsid-
ered themajor risk factors for oral cancer, risk
also increases with age. An increasingly im-
portant risk factor fororopharyngeal cancer is
sexually transmittedoral HPV infection (HPV-
16). Yet all adults—not only high risk individ-
uals—should be screened for oral cancer, ac-
cording to Dr. Poh, who says there has been
an increase in thenumberofyounger-ageoral
cancer patients andpatientswithout obvious
known risk factors. “It’s time to consider and
conducta large-scale,multi-centre studywith
a standardized protocol to investigate this
potentially life-savingmeasure. What’s need-
ed is more solid research-based evidence
to answer the questions ‘Should we screen
or not screen for oral cancer? Are adjunctive
techniques useful, and what is their value in
screening?’
a
Indentistry, screening fororal cancerbyvisual inspection
and palpation is an essential part of a clinician’s routine
practise. Yet achieving the goals of screening—
identification of precancerous lesions or cancers so that
interventions can reduce malignant transformations or
improvechancesofsurvival—canbeamajorchallenge.
References
Complete listofreferencesavailableat:
Despite inconclusive
evidence, dentists should remain
vigilant for signs of precancerous
or cancerous lesions inall patients
while performing routine
follow-upandnew patient oral
examinations.
