Perspective on oral cancer screening: Time for implementation research and beyond.

Screening aims to detect cancer in asymptomatic populations. In oral cancer, clinical oral examination is the current standard method for screening. Oral cancer screening may be performed by a physician or a healthcare workers and is an affordable and feasible method. There is some evidence that this low-cost method is effective in decreasing mortality from oral cancer in high risk population. The cluster-randomised trial in India that had 15 years of follow-up reported an 81 % mortality reduction in high-risk populations of tobacco and/or alcohol users who adhered to four screening rounds. The observational studies similarly reported 21-22 % reduction in advanced oral cancer and 24-26 % reduction in oral cancer mortality among high risk population. Implementation and evaluation of oral cancer screening programmes in high risk population will support the goals of the World Health Organisation on global oral health.

Effectiveness of screening for oral cancer and oral potentially malignant disorders (OPMD): A systematic review.

Oral cancer (OC) is a debilitating disease with a high mortality rate when diagnosed in advanced stage. Conversely, early-stage OC has a high survival rate, supporting a need for early detection programmes. A previous systematic review of clinical trials evaluating efficacy of screening for OC was inconclusive. This systematic review aimed to determine the impact of screening for oral lesions on reducing mortality and incidence of OC by looking at a broader spectrum of evidence. The search for randomized controlled trials and observational studies with a control group was conducted in PubMed, OVID, Cochrane, CINAHL and grey literature sources. Risk of bias for included studies was assessed with the tools developed by the Cochrane collaboration. Six out of two identified randomized trials and five observational studies had moderate to high risk of bias. Nevertheless, the predictions on impact of OC screening on incidence and mortality were similar across the majority of the studies. The meta-analysis concluded on a 26% decrease in OC mortality, and an 19% decrease in advanced OC cases as a result of OC screening in high-risk population. Three out of four studies did not identify an impact of screening on OC incidence. No positive impact of OC screening on incidence or mortality among general population was identified in the only available randomized trial. Consistency in the outcomes and the limitations of the few available studies suggest a need for real-life setting research to evaluate the overall effectiveness of screening for OC in high-risk population.