Evidence-Based Clinical Recommendations Regarding Screening for Oral Squamous Cell Carcinomas

Oral cancer screening for asymptomatic adults: do the United States Preventive Services Task Force draft guidelines miss the proverbial forest for the trees?

“…Other expert groups have reached comparable conclusions. For example, the reader is referred to the "Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas 5 " recently published by a panel convened by the American Dental Association (ADA) Council on Scientific Affairs, which however takes a more pragmatic approach to this question. Specifically, the USPSTF was unable to offer a recommendation on the benefits versus risks of routine visual oral cancer screening of asymptomatic patients who present in the primary care setting.…”

“…Consequently, as educators, it is critical that our dental school graduates are both proficient and confident in their ability to assess soft tissue lesions. Additionally, as suggested in the recent guidelines from the ADA's Council on Scientific Affairs referred to previously, "the clinician can reduce the risk of performing unnecessary biopsies by obtaining an opinion by a dental or medical care provider who has advanced training and experience in diagnosis of oral cancer and its precursor lesions 5 . "…”

Total Diagnostic Delay in Oral Cancer may be Related to Advanced Disease Stage at Diagnosis

“…9,10 The American Dental Association (ADA) developed clinical recommendations regarding screening for oral squamous cell carcinomas during routine examinations, encouraging practitioners to "remain alert for signs of potentially malignant lesions or early stage cancers while performing routine visual and tactile examinations," particularly among tobacco and alcohol users. 11 In addition, neither the Cochrane review nor the ADA recommendations found sufficient evidence to recommend adjunctive technologies, such as toluidine blue, fluorescence imaging, or brush biopsy in screening for oral cancer. 9,11 This study showed that patients with delayed diagnosis were significantly more likely to present with an advanced-stage cancer at diagnosis compared with those with no delay in diagnosis.…”

“…11 In addition, neither the Cochrane review nor the ADA recommendations found sufficient evidence to recommend adjunctive technologies, such as toluidine blue, fluorescence imaging, or brush biopsy in screening for oral cancer. 9,11 This study showed that patients with delayed diagnosis were significantly more likely to present with an advanced-stage cancer at diagnosis compared with those with no delay in diagnosis. The Healthy People 2020 initiative for the United States includes overall goals to reduce health disparities in the general population, which includes individuals at higher risk and those who suffer from a greater burden of oral diseases, such as oral and pharyngeal cancer.…”

Biopsia por cepillado con el OralCDx®: Estado de la cuestión

“…En varias revisiones sistemáticas se concluyó que no existe evidencia suficiente para apoyar el uso de esta prueba diagnóstica como una técnica general de detección de Cáncer Oral (CO) y LOMP (9)(10)(11)(12)30). Una revisión Cochrane, de ensayos clínicos prospectivos, se concluyó que la utilización de una prueba como el OralCDx ® no reduce la tasa de mortalidad asociada al CO (9).…”