Effectiveness of screening for oral cancer not proven: Are screening programmes effective in reducing mortality rates from oral cancer?

Data sources Electronic databases (Medline, Cancerlit, Embase, the Cochrane Central Register of Controlled Trials) from 1966 to September 2002 and the Cochrane Library up to issue 2 in 2002 were searched. Searches by hand of specific journals and bibliographies were also made and corresponding authors contacted to identify published and unpublished work. Study selection Studies were required to be randomised controlled trials (RCT) that screened for oral cancer or potentially premalignant oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy.Data extraction and synthesis Data were extracted independently by two reviewers. Results Only one RCT met the review's inclusion criteria. This one ongoing trial has 13 clusters of 153 708 eligible subjects and 130 799 included subjects. There was no difference in the age-standardised oral cancer mortality rates for the screened group (21.2/100 000 person–years) and the control group (21.3/100 000 person–years). This study has some methodological weaknesses, however. Conclusions Given the limited evidence (only one RCT) and the potential methodological weakness in that study, it is not possible to say whether there is evidence to support or refute the use of a visual examination as a method of screening for oral cancer in the general population. Furthermore, no robust evidence exists to suggest whether other methods of screening — toluidine blue, fluorescence imaging or brush biopsy — are either beneficial or harmful. Further cost-effective, high-quality studies to assess the efficacy and effectiveness of screening are required. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high-risk groups are needed. © EBD 2004.