Five-year survival of oral cancer varies from 81% for patients with localized disease to 42% for those with regional disease and to 17% if distant metastases are present. Generally, due to late-stage diagnosis, fewer than 50% of patients with oral and pharyngeal cancers survive more than 5 years. This rate has remained disappointingly low and relatively constant during the last few decades. Therefore there is need to create awareness for oral cancer screening so that the deadly disease can be diagnosed at an early stage.
Dear Dr. Rahman,
In my opinion the best way to mass screen for oral cancer is proper clinical oral examination. There are lots of adjunct diagnostic aids like toluidine blue, ViziLite Plus, MicroLux DL, and VELscope. But none of them have proved themselves. Please see below links to a good review article and also the oral cancer foundation screening protocols, which you may find helpful.
Thank you
Lakshmanan Suresh
http://www.oralcancerfoundation.org/dental/pdf/Lingen-visual-aid-review.pdf
http://www.oralcancerfoundation.org/discovery-diagnosis/screening.php
Dear Farzan, perhaps you may find the attached article suitable for you to ponder.
Accuracy of Screening for Potentially Malignant Disorders of the Oral Mucosa by Dentists in Primary Care
http://ohpd.quintessenz.de/index.php?doc=abstract&abstractID=25698/
Dear Farzan,your question is pertinent and must be discussed.The best results for oral cancer is the diagnosis in early stages(I and II) and for III and IV stages the results are poor.I suggest that for stages I and II the inclusion of PETCT in therapy planning considered that the clinical evaluation is not adequated to measure the prognosis.
Isn't the first question to be asked does any screening method improve the outcome in patients with oral cancer rather than which screening method should i use?
For patients in the general population I think the answer is a clear no for an organized program (this is also the consensus of the american preventative services taskforce ), for high risk individuals there is some data to suggest a benefit but if we are serious we should institute a confirmatory large trial in such patients to confirm. In the meantime perhaps opportunistic screening of high risk individuals
See Screening programmes for the early detection and prevention of oral cancer.
Brocklehurst P1, Kujan O, O'Malley LA, Ogden G, Shepherd S, Glenny AM. Cochrane Database Syst Rev. 2013
Main results: A total of 3239 citations were identified through the searches. Only one RCT, with 15-year follow-up met the inclusion criteria (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the oral cancer mortality rates for the screened group (15.4/100,000 person-years) and the control group (17.1/100,000 person-years), with a RR of 0.88 (95% CI 0.69 to 1.12). A 24% reduction in mortality was reported between the screening group (30/100,000 person-years) and the control group (39.0/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant (RR 0.76; 95% CI 0.60 to 0.97). No statistically significant differences were found for incidence rates. A statistically significant reduction in the number of individuals diagnosed with stage III or worse oral cancer was found for those in the screening group (RR 0.81; 95% CI 0.70 to 0.93). No harms were reported. The study was assessed as at high risk of bias.
I think that early diagnosis is essential, but the patients are always delayed for seeking speacialist's helps. We try to develop the approximate methods to take those difficulties.
The general practioners are always the first line of health personnels. General dental education in oral pathology should be emphsized again.
Dear Chih-Yi Lai,I aggree with you.The best method is the law to oblige the oral exemination once a year,
By far the best method is, yet, examination by a trained clinician. Easiness of access makes visual inspection the best tool. Someday a more automated method will reach the same level of accuracy and efficiency of a trained clinician, but that is not the case now. Additionally, the rate of price/benefit still keeps clinicians on top of automated methods. To create awareness about oral cancer, I believe, we should follow the path of cervical and breast cancer.
The best way of doing that is to spread the knowledge of the early signs and symptoms of oral cancer, and where to go when you have such a complaint. I do not think that mass screening of oral cancer is cost effective.
Dear Nader,I agree with you.I would include for initial cases molecular prognostic markers to design a new oral cancer therapy
Patients are not aware of oral cancer because it is painless to start with. So we need to educate primary healthcare physicians about the signs and symptoms of oral cancer. usually there is a delay of two months before patient seeks specialist treatment. this is because many primary physicians are unaware of oral cancer. proper clinical examination remains the bedrock of screening.
More easy diagnostic biomarker is hoped.The design not only for speacialists, but also for general practioners.General practioners are always the first line of cancer discoverers.
Dear Farzan Rahman, Raman spectroscopy is a technique that is very suitable for screnning of Squamous cell carcinoma.
Here you can find some nice studies which are showing that
Discrimination between Oral Cancer and Healthy Tissue Based on Water Content Determined by Raman Spectroscopy (http://pubs.acs.org/doi/abs/10.1021/ac504362y)
Method development: Raman spectroscopy-based histopathology of oral mucosa(https://www.researchgate.net/publication/260630339_Method_development_Raman_spectroscopy-based_histopathology_of_oral_mucosa?ev=prf_pub)
Enjoy.
Regards,
Elisa Barroso
Article Method development: Raman spectroscopy-based histopathology ...
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