Screening for oral cancer: Future prospects, research and policy development for Asia

•The performance of oral cancer and precancer screening studies undertaken by visual oral examination (OVE) have an acceptable sensitivity and specificity.•OVE poses a reasonable discriminatory ability to identify mucosal diseases.•There is no doubt that early detection of oral cancer is the key iss...

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Published in:Oral oncology Vol. 105; p. 104632
Main Authors: Nagao, Toru, Warnakulasuriya, Saman
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01-06-2020
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Summary:•The performance of oral cancer and precancer screening studies undertaken by visual oral examination (OVE) have an acceptable sensitivity and specificity.•OVE poses a reasonable discriminatory ability to identify mucosal diseases.•There is no doubt that early detection of oral cancer is the key issue to reduce cancer mortality.•The benefits and effectiveness of oral cancer screening to reduce mortality still remains controversial.•Only one RCT study conducted in India elucidated that mass population screening of high-risk groups has the potential to reduce cancer mortality screening also contributed downstaging oral cancers.•However, data from this study cannot be generalized to low risk populations in industrialized countries.•In this review advantages and disadvantages for oral cancer screening are discussed.•The focus is with particular reference to high incidence countries in Asia.•Further research on improving awareness and education to reduce diagnostic delays, comprehensive tobacco and areca nut cessation programs are needed.•Developing low-cost tools to identify high risk individuals and lesions are proposed. Although the incidence of oral cavity cancer is high among low and middle income countries in Asia where the risk habits (tobacco smoking, tobacco chewing and betel quid use) are common, the benefits for introducing oral cancer screening for the whole population in these countries still remains controversial. It is disappointing, but not surprising that many of studies, without control arms, could not provide a clear answer as to whether screening is effective in reducing mortality or combating rising incidence trends. Only one Indian study that reported a randomized controlled trial (RCT) elucidated that mass screening for high risk groups could significantly reduce the cancer mortality or down-stage cancers detected by screening. Several professional organizations that considered any potential benefits of oral cancer screening remain unconvinced that the current knowledge on its natural history, available tests and interventions to treat potentially malignant disorders satisfy the desirable criteria to recommend organized screening for oral cancer. In this review we discuss advantages and disadvantages for oral cancer screening particularly with reference to high incidence countries in Asia. If screening is undertaken, we propose that it is targeted to high risk groups and to combine screening with education on risky life-styles so that overall incidence can be reduced in the future. Further research on increasing public awarenes and impact of professional education such as e-learning to reduce diagnostic delays, studies on the natural history of oral potentially malignant disorders and cancer, comprehensive tobacco and areca nut cessation programs, developing tools to identify high-risk individuals and high-risk lesions are proposed.
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ISSN:1368-8375
1879-0593
DOI:10.1016/j.oraloncology.2020.104632