Risk Stratification System for Oral Cancer Screening

Area of Science:

• Oncology
• Biomarkers
• Cancer Prevention

Background:

• Oral cavity and oropharyngeal cancer (oral cancer) incidence is rising globally, with a 5-year survival rate of only 50% due to late-stage diagnosis.
• Early detection of oral cancer (stages I and II) significantly improves survival rates to 80%-90%.
• Salivary soluble CD44 (CD44), a tumor-initiating marker, and total protein are potential biomarkers for early oral cancer risk assessment.

Purpose of the Study:

• To determine if salivary CD44 and total protein levels are associated with oral cancer, independent of known risk factors.
• To evaluate the sensitivity and specificity of these salivary markers for oral cancer detection in different populations.
• To assess the utility of these markers for early intervention and risk stratification in high-risk individuals.

Main Methods:

• A hospital-based study involving 150 oral cancer cases and 150 matched controls.
• Analysis of salivary soluble CD44 and total protein levels in oral rinses.
• Follow-up of 150 high-risk individuals in a community prevention program over 1 year to assess marker specificity and variation.

Main Results:

• Elevated salivary CD44 (≥5.33 ng/mL) was strongly associated with oral cancer case status (adjusted OR 14.489, P < .0001).
• Total protein levels improved predictive accuracy when combined with CD44.
• In a high-risk community, specificity reached 74% and improved to 95% after annual retesting, indicating potential for screening.

Conclusions:

• Simple, inexpensive salivary CD44 and total protein measurements can aid in identifying individuals at heightened risk for oral cancer.
• These salivary biomarkers may facilitate early intervention, potentially improving survival rates for oral cancer.
• The findings suggest a promising role for salivary diagnostics in large-scale oral cancer screening programs targeting at-risk populations.