Abstract
Data sources
The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and CANCERLIT.
Study selection
Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy were included. There were no restrictions regarding language or date of publication.
Data extraction and synthesis
The original review identified 1,389 citations and this update identified an additional 330 studies. Validity assessment, data extraction and statistics evaluation were undertaken by six independent review authors.
Results
Only one 9-year cluster RCT was included (n = 13 clusters: 191,873 participants). No statistically significant differences 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) were identified. 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.
Conclusions
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 RCTs are recommended to assess the efficacy, effectiveness and cost-effectiveness of a visual examination as part of a population based screening programme.
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Authors and Affiliations
Additional information
Address for correspondence: Luisa Fernandez Mauleffinch, Review Group Co-ordinator, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. E-mail: luisa.fernandez@manchester.ac.uk
Brocklehurst P, Kujan O, Glenny AM, Oliver R, Sloan P, Ogden G, Shepherd S. Screening programmes for the early detection and prevention of oral cancer. Cochrane Database of Systematic Reviews 2010, Issue 11.
This paper is based on a Cochrane Review published in the Cochrane Library 2010, issue 2 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.
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Richards, D. Oral cancer screening programmes. Evid Based Dent 11, 103 (2010). https://doi.org/10.1038/sj.ebd.6400751
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DOI: https://doi.org/10.1038/sj.ebd.6400751
