Screening programmes for the early detection and prevention of oral cancer

Paul Brocklehurst, Omar Kujan, Anne-Marie Glenny, Richard Oliver, Philip Sloan, Graham Ogden, Simon Shepherd

    Research output: Contribution to journalReview article

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    Abstract

    Background

    Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with oral cancer, there is a need to determine the effectiveness of a screening programme for this disease, either as a targeted, opportunistic or population based measure. Evidence exists from modelled data that a visual oral examination of high-risk individuals may be a cost-effective screening strategy and the development and use of adjunctive aids and biomarkers is becoming increasingly common.

    Objectives

    To assess the effectiveness of current screening methods in decreasing oral cancer mortality.

    Search strategy

    The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 20 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 20 May 2010), EMBASE viaOVID(1980 to 20 May 2010) and CANCERLIT via PubMed (1950 to 20 May 2010). There were no restrictions regarding language or date of publication.

    Selection criteria

    Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy.

    Data collection and analysis

    The original review identified 1389 citations and this update identified an additional 330 studies, highlighting 1719 studies for consideration. Only one study met the inclusion criteria and validity assessment, data extraction and statistics evaluation were undertaken by six independent review authors.

    Main results

    One 9-year RCT has been included (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the age-standardised oral cancer mortality rates for the screened group (16.4/100,000 person-years) and the control group (20.7/100,000 person-years). A 43% reduction in mortality was reported between the intervention cohort (29.9/100,000 person-years) and the control arm (45.4/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant. However, this study had a number of methodological weaknesses and the associated risk of bias was high.

    Authors' conclusion

    Although there is evidence that a visual examination as part of a population based screening programme reduced the mortality rate of oral cancer in high-risk individuals, whilst producing a stage shift and improvement in survival rates across the population as a whole, the evidence is limited to one study and is associated with a high risk of bias. This was compounded by the fact that the effect of cluster randomisation was not accounted for in the analysis. Furthermore, no robust evidence was identified to support the use of other adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging within a primary care environment. Further randomised controlled trials are recommended to assess the efficacy, effectiveness and cost-effectiveness of a visual examination as part of a population based screening programme.
    This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 11. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    Original languageEnglish
    Article numberCD004150
    Pages (from-to)CD004150
    Number of pages28
    JournalCochrane Database of Systematic Reviews
    Issue number11
    DOIs
    Publication statusPublished - 2010

    Keywords

    • Mass Screening [methods]
    • Mouth Neoplasms [diagnosis; mortality; prevention & control]
    • Physical Examination [methods]
    • Randomized Controlled Trials as Topic
    • Humans
    • POTENTIALLY MALIGNANT DISORDERS
    • SQUAMOUS-CELL CARCINOMA
    • TOLUIDINE BLUE
    • PHARYNGEAL CANCER
    • BREAST-CANCER
    • PREMALIGNANT LESIONS
    • OROPHARYNGEAL CANCER
    • DIAGNOSTIC AIDS
    • PRIMARY-CARE
    • MORTALITY

    Cite this

    Brocklehurst, Paul ; Kujan, Omar ; Glenny, Anne-Marie ; Oliver, Richard ; Sloan, Philip ; Ogden, Graham ; Shepherd, Simon. / Screening programmes for the early detection and prevention of oral cancer. In: Cochrane Database of Systematic Reviews. 2010 ; No. 11. pp. CD004150.
    @article{b20dd850b02d4a7390f7adac36cc387d,
    title = "Screening programmes for the early detection and prevention of oral cancer",
    abstract = "Background Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with oral cancer, there is a need to determine the effectiveness of a screening programme for this disease, either as a targeted, opportunistic or population based measure. Evidence exists from modelled data that a visual oral examination of high-risk individuals may be a cost-effective screening strategy and the development and use of adjunctive aids and biomarkers is becoming increasingly common. Objectives To assess the effectiveness of current screening methods in decreasing oral cancer mortality. Search strategy The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 20 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 20 May 2010), EMBASE viaOVID(1980 to 20 May 2010) and CANCERLIT via PubMed (1950 to 20 May 2010). There were no restrictions regarding language or date of publication. Selection criteria Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy. Data collection and analysis The original review identified 1389 citations and this update identified an additional 330 studies, highlighting 1719 studies for consideration. Only one study met the inclusion criteria and validity assessment, data extraction and statistics evaluation were undertaken by six independent review authors. Main results One 9-year RCT has been included (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the age-standardised oral cancer mortality rates for the screened group (16.4/100,000 person-years) and the control group (20.7/100,000 person-years). A 43{\%} reduction in mortality was reported between the intervention cohort (29.9/100,000 person-years) and the control arm (45.4/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant. However, this study had a number of methodological weaknesses and the associated risk of bias was high. Authors' conclusion Although there is evidence that a visual examination as part of a population based screening programme reduced the mortality rate of oral cancer in high-risk individuals, whilst producing a stage shift and improvement in survival rates across the population as a whole, the evidence is limited to one study and is associated with a high risk of bias. This was compounded by the fact that the effect of cluster randomisation was not accounted for in the analysis. Furthermore, no robust evidence was identified to support the use of other adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging within a primary care environment. Further randomised controlled trials are recommended to assess the efficacy, effectiveness and cost-effectiveness of a visual examination as part of a population based screening programme. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 11. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.",
    keywords = "Mass Screening [methods], Mouth Neoplasms [diagnosis; mortality; prevention & control], Physical Examination [methods], Randomized Controlled Trials as Topic, Humans, POTENTIALLY MALIGNANT DISORDERS, SQUAMOUS-CELL CARCINOMA, TOLUIDINE BLUE, PHARYNGEAL CANCER, BREAST-CANCER, PREMALIGNANT LESIONS, OROPHARYNGEAL CANCER, DIAGNOSTIC AIDS, PRIMARY-CARE, MORTALITY",
    author = "Paul Brocklehurst and Omar Kujan and Anne-Marie Glenny and Richard Oliver and Philip Sloan and Graham Ogden and Simon Shepherd",
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    doi = "10.1002/14651858.CD004150.pub3",
    language = "English",
    pages = "CD004150",
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    number = "11",

    }

    Screening programmes for the early detection and prevention of oral cancer. / Brocklehurst, Paul; Kujan, Omar; Glenny, Anne-Marie; Oliver, Richard; Sloan, Philip; Ogden, Graham; Shepherd, Simon.

    In: Cochrane Database of Systematic Reviews, No. 11, CD004150, 2010, p. CD004150.

    Research output: Contribution to journalReview article

    TY - JOUR

    T1 - Screening programmes for the early detection and prevention of oral cancer

    AU - Brocklehurst, Paul

    AU - Kujan, Omar

    AU - Glenny, Anne-Marie

    AU - Oliver, Richard

    AU - Sloan, Philip

    AU - Ogden, Graham

    AU - Shepherd, Simon

    PY - 2010

    Y1 - 2010

    N2 - Background Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with oral cancer, there is a need to determine the effectiveness of a screening programme for this disease, either as a targeted, opportunistic or population based measure. Evidence exists from modelled data that a visual oral examination of high-risk individuals may be a cost-effective screening strategy and the development and use of adjunctive aids and biomarkers is becoming increasingly common. Objectives To assess the effectiveness of current screening methods in decreasing oral cancer mortality. Search strategy The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 20 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 20 May 2010), EMBASE viaOVID(1980 to 20 May 2010) and CANCERLIT via PubMed (1950 to 20 May 2010). There were no restrictions regarding language or date of publication. Selection criteria Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy. Data collection and analysis The original review identified 1389 citations and this update identified an additional 330 studies, highlighting 1719 studies for consideration. Only one study met the inclusion criteria and validity assessment, data extraction and statistics evaluation were undertaken by six independent review authors. Main results One 9-year RCT has been included (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the age-standardised oral cancer mortality rates for the screened group (16.4/100,000 person-years) and the control group (20.7/100,000 person-years). A 43% reduction in mortality was reported between the intervention cohort (29.9/100,000 person-years) and the control arm (45.4/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant. However, this study had a number of methodological weaknesses and the associated risk of bias was high. Authors' conclusion Although there is evidence that a visual examination as part of a population based screening programme reduced the mortality rate of oral cancer in high-risk individuals, whilst producing a stage shift and improvement in survival rates across the population as a whole, the evidence is limited to one study and is associated with a high risk of bias. This was compounded by the fact that the effect of cluster randomisation was not accounted for in the analysis. Furthermore, no robust evidence was identified to support the use of other adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging within a primary care environment. Further randomised controlled trials are recommended to assess the efficacy, effectiveness and cost-effectiveness of a visual examination as part of a population based screening programme. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 11. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    AB - Background Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with oral cancer, there is a need to determine the effectiveness of a screening programme for this disease, either as a targeted, opportunistic or population based measure. Evidence exists from modelled data that a visual oral examination of high-risk individuals may be a cost-effective screening strategy and the development and use of adjunctive aids and biomarkers is becoming increasingly common. Objectives To assess the effectiveness of current screening methods in decreasing oral cancer mortality. Search strategy The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 20 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 20 May 2010), EMBASE viaOVID(1980 to 20 May 2010) and CANCERLIT via PubMed (1950 to 20 May 2010). There were no restrictions regarding language or date of publication. Selection criteria Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy. Data collection and analysis The original review identified 1389 citations and this update identified an additional 330 studies, highlighting 1719 studies for consideration. Only one study met the inclusion criteria and validity assessment, data extraction and statistics evaluation were undertaken by six independent review authors. Main results One 9-year RCT has been included (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the age-standardised oral cancer mortality rates for the screened group (16.4/100,000 person-years) and the control group (20.7/100,000 person-years). A 43% reduction in mortality was reported between the intervention cohort (29.9/100,000 person-years) and the control arm (45.4/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant. However, this study had a number of methodological weaknesses and the associated risk of bias was high. Authors' conclusion Although there is evidence that a visual examination as part of a population based screening programme reduced the mortality rate of oral cancer in high-risk individuals, whilst producing a stage shift and improvement in survival rates across the population as a whole, the evidence is limited to one study and is associated with a high risk of bias. This was compounded by the fact that the effect of cluster randomisation was not accounted for in the analysis. Furthermore, no robust evidence was identified to support the use of other adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging within a primary care environment. Further randomised controlled trials are recommended to assess the efficacy, effectiveness and cost-effectiveness of a visual examination as part of a population based screening programme. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 11. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    KW - Mass Screening [methods]

    KW - Mouth Neoplasms [diagnosis; mortality; prevention & control]

    KW - Physical Examination [methods]

    KW - Randomized Controlled Trials as Topic

    KW - Humans

    KW - POTENTIALLY MALIGNANT DISORDERS

    KW - SQUAMOUS-CELL CARCINOMA

    KW - TOLUIDINE BLUE

    KW - PHARYNGEAL CANCER

    KW - BREAST-CANCER

    KW - PREMALIGNANT LESIONS

    KW - OROPHARYNGEAL CANCER

    KW - DIAGNOSTIC AIDS

    KW - PRIMARY-CARE

    KW - MORTALITY

    U2 - 10.1002/14651858.CD004150.pub3

    DO - 10.1002/14651858.CD004150.pub3

    M3 - Review article

    SP - CD004150

    JO - Cochrane Database of Systematic Reviews

    JF - Cochrane Database of Systematic Reviews

    SN - 1469-493X

    IS - 11

    M1 - CD004150

    ER -