Oral exam.

Top Line: Is oral cavity cancer screening effective at reducing disease mortality?

The Study: According to the USPSTF, there is inadequate evidence to support any particular oral cancer screening strategy. One of the largest trials to ask this question was the Kerala Oral Cancer Screening Trial where 13 geographic clusters in India were randomized to home-based screening every 3 years by trained health workers (not dentists or physicians). It was a huge study with >95,000 participants in the screening arm and found a non-significant (21%) relative reduction in oral cancer mortality in a general population. However, in patients who were ever-tobacco or ever-alcohol users, there did seem to be significant benefit. This re-analysis of the Kerala Trial generated a risk model that addresses many of the criticisms of the original study design. After accounting for factors like the intensity and duration of tobacco smoking, chewing, and/or alcohol consumption, they found a significant 27% relative reduction in cancer mortality. The risk model also helped identify the highest risk subset of people who derived the greatest absolute benefit from screening. Such a risk-based approach increased the efficiency of screening and reduced the number needed to screen from >2000 to ~600.

TBL: A risk-based approach to oral cavity cancer screening may increase both the efficiency and magnitude of benefit of screening efforts. | Cheung, J Clin Oncol 2021