Oral cancer has a high morbidity and mortality rate and clinical examination has resulted in late diagnosis. What reason has led to a delay in the implementation of a complementary screening test to the conventional clinical test?
Screening has always been done at the time of clinical examination if we found any pre-malignant lesion or condition or any other lesion detected during intraoral examination. It may be missed or delayed either due to patient's negligence if they don't report at time. Therefore, patient's awareness required regarding any lesion or growth they noticed should get checked at early as possible.
Dear Kumari Deepika , i appreciate your answer. Indeed, the delay in seeking dental care is a complicating factor. However, I cannot make comments here so as not to direct other answers. I just try to see each one's point of view regarding the barriers in screening and diagnosing oral cancer. Although, only this year, it has diagnosed 3 children without known predisposing factors in the age group of 5 to 8 years with squamous cell carcinoma and who have already died. Outside the range of over 40 years of age, without known harmful habits and even if there were, there would not be a time factor for the development of alterations linked to these factors. So without going into details that might specifically direct colleagues to reflect on a specific theme of this big problem I would like to hear more from other researchers.
What actually leads us not to think about and discuss the implementation of exams complementary to the clinical exam in Dentistry, such as those that already exist in so many other areas such as PSA, mammography and ultrasound, pap smears and/or exfoliative cytology?
Also, why are we so demanding with exams that arise as possibilities for Dentistry, considering that even those mentioned above in medicine will never reach 100% of specificity or sensitivity?
Dear Dr. Sérgio Araújo Andrade
Presently, no test has been shown to be effective for accurate detection of oral lesions in the context of a screening programme with sensitivities and specificities like those reported for breast and cervical cancer screening programmes.
We need to know more about the natural history of the disease, particularly the biology of potentially malignant lesions, and we need biomarkers that can be used to develop a test which is more specific and will identify only those lesions which are most likely to progress to cancer.
Therefore, for oral cancer, screening test has not been implemented. However, those with high-risk habits such as alcohol and tobacco users should be vigilant and should perform regular mouth examination to detect the presence of mucosal changes which may be associated with potentially malignant disorders or early mouth cancer.
You may want to refer to the article attached below. It may be helpful!
https://www.nature.com/articles/sj.bdj.2018.918
Regards,
Malcolm Nobre
Dear Malcolm Nobre I really appreciate every response lead and I'm sorry not to lead a debate so as not to influence new responses. Biomarkers are very interesting, really, but would they allow us to say where the cancer actually is in a molecular stage, let's say (on the tongue? on the soft palate? on the floor?) and how to identify the real location at a stage that biomarkers theoretically allow to identify , at the molecular level or would we have to know that we have a probability of oral cancer and then wait for clinical evidence later to locate the tumor? . Westra explains this issue well. Do other methods in other areas really have great sensitivity or specificity or would it be the approach that facilitates, for example, being able to remove the entire tissue where, in the mouth, we do not have such an approach to remove the entire oral cavity.I really appreciate every direct response about oral cancer screening. who knows, one more question: could it be that many studies no longer confuse screening with diagnosis and brilliant works are lost by a mere confusion of basic concepts? very grateful
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