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Oral Cancers and Potentially Malignant Disorders: Population-Based Interventions for Early Detection

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What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review on the effectiveness of oral cancer screening programs (Brocklehurst et al., 2013; search period 1950-2013). No studies evaluating the effectiveness of other forms of population-based interventions, with relevant health-related outcomes, were identified. The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to oral health. This finding updates and replaces the 2000 Task Force finding on Population-Based Interventions for Early Detection for Oral and Pharyngeal Cancers pdf icon [PDF - 224 kB].

Context

The updated search for evidence identified a systematic review that evaluated the accuracy of screening tests for the early detection of oral cancers and potentially malignant disorders. Findings from this review are covered comprehensively by the U.S. Preventive Services Task Force.

Summary of Results

Detailed results from the systematic review are available in the Task Force Finding and Rationale Statement pdf icon [PDF - 175 kB]

One study qualified for the review.

  • A single study looking at the effectiveness of screening programs for improving oral cancer outcomes showed a 24% reduction in oral cancer mortality in high-risk individuals (those who used tobacco or alcohol or both).
  • The study also showed that the proportion of cancers diagnosed as stage III or worse were significantly lower among those participants undergoing screening (53%) compared to those who did not receive screening (65%).

Summary of Economic Evidence

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.

 

Applicability

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

 

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

  • High quality research in needed in different settings with populations that have varying cancer rates.
  • Studies are needed to evaluate the effectiveness of other forms of population-based initiatives, such as public awareness campaigns and educational interventions, with relevant health-related outcomes.
  • More research is needed on the steps that follow initial detection and diagnosis, including management of potentially malignant disorders, effective treatment strategies, potential markers that can predict the likelihood for developing into a malignancy, time frame for progression, and patients' knowledge and compliance with referrals and follow-up.
  • Continuing research should be done to help identify those at higher risk for oral cancer, particularly as causes emerge or become more common (e.g., infection with human papillomavirus [HPV])

Study Characteristics

  • The one included study was conducted in India, where the incidence of oral cancer is greater than in the U.S.
  • The randomized controlled trial had a large sample size (n=191,873) and 15 years of follow-up data.