Screening for oral cancer: contributing to the debate

Screening, or "case detection", is controversial and central to much debate in the world of medicine. In the present study, we evaluate oral cancer screening against the National (UK) Screening Committee criteria in the context of the most recent research in this field. Oral cancer is a complex, debilitating disease that is increasing in incidence in the UK and in most parts of Western Europe. It has multifactorial etiology, and these major risk factors are well researched, allowing definition of an "at-risk" population. However, our understanding of its natural history of progression from potentially malignant disorders to malignancy is limited; the field lacks high-quality, randomized, controlled trials, bar one published study. Evidence is also available to suggest that visual screening by sufficiently trained examiners results in earlier detection (down staging) of the disease, which lends itself towards more successful treatment. Sensitive screening tools to aid and confirm findings following a visual inspection are yet to be developed. Nevertheless, new tests continue to arise based on knowledge gleaned from research into the biomarkers. This review discusses the evidence based around the oral cancer screening debate and highlights areas in which more research is required before the advent of a successful and effective screening program.