Oral cancer screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

There is insufficient evidence to recommend routine screening for oral cancer.

Screening

The goal of oral cancer screening is to detect mouth cancer or precancerous lesions that may lead to mouth cancer but no studies have proved that oral cancer screening saves lives. People with a high risk of oral cancer may be more likely to benefit from oral cancer screening.

There is no standard or routine screening test for oral cancer

There is inadequate evidence to establish whether screening would result in a decrease in mortality from oral cancer.

Detection of cases that are already incurable, leading to increased morbidity. Unnecessary treatment associated with overdiagnosis. Psychologic consequences of false-positive tests. Misdiagnosis due to variability in assessment of biopsies.

Screening for oral cancer may be done during a routine check-up by a dentist or medical doctor. The exam will include looking for lesions, including areas of leukoplakia (an abnormal white patch of cells) and erythroplakia (an abnormal red patch of cells). Leukoplakia and erythroplakia lesions on the mucous membranes may become cancerous. If lesions are seen in the mouth, the following procedures may be used to find abnormal tissue that might develop into oral cancer:

• Toluidine blue stain: A procedure in which lesions in the mouth are coated with a blue dye. Areas that stain darker are more likely to be cancer or become cancer.

Fluorescence staining: A procedure in which lesions in the mouth are viewed using a special light. After the patient uses a fluorescent mouth rinse, normal tissue looks different from abnormal tissue when seen under the light.

• Exfoliative cytology: A procedure to collect cells from the lip or oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.
• Brush biopsy: The removal of cells using a brush that is designed to collect cells from all layers of a lesion. The cells are viewed under a microscope to find out if they are abnormal.

More than half of oral cancers have already spread to lymph nodes or other areas by the time they are found. No studies have shown that screening would decrease the risk of dying from this disease.

Risks of Oral Cavity and Oropharyngeal Cancer Screening

Detection of cases that are already incurable, leading to increased morbidity. Unnecessary treatment associated with overdiagnosis. Psychologic consequences of false-positive tests. Misdiagnosis due to variability in assessment of biopsies.