There is insufficient evidence to determine whether having primary care clinicians screen for oral cancer in adults without symptoms offers benefits or harms, reported the US Preventive Services Task Force (USPSTF) in an updated recommendation released today by the Annals of Internal Medicine. The recommendation, which updates a 2004 recommendation with similar findings, applies only to primary care clinicians, not dentists or otolaryngologists.
Oral cancer screening (visual inspection and palpation) in adults without symptoms typically involves screens for oral cancers—cancers of the lip and oral cavity—and pharyngeal cancers that emerge in the throat. In the United States, approximately 41 000 new cases of and almost 8000 deaths from cancer of the oral cavity and pharynx will occur this year.
Five-year survival is 82.4% for localized disease. However, more than half of individuals with oral and pharyngeal cancer have regional or distant metastases at the time they are diagnosed, which have lower 5-year survival rates: 55.5% of patients with regional lymph node spread and 33.2% of patients with distant metastases are alive 5 years after diagnosis. The hope is that screening for oral cancer will identify the cancer before it spreads, allowing for more successful treatment.
But the USPSTF found inadequate evidence that oral screening examinations by primary care clinicians in asymptomatic adults accurately detect oral cancer or that treatment of screen-detected oral cancer improves outcomes or mortality risk. The task force also found inadequate evidence on the potential harms of screening.
A 2008 survey of US adults found almost 30% reported having an oral cancer examination by a physician, dentist, or other health professional, although it is unknown what percentage of these exams were conducted by dentists rather than primary care physicians or other health professionals.
Noting that up to 75% of oral cancer diagnoses in the United States may be attributed to tobacco and alcohol use, the USPSTF did recommend that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those using tobacco products. The task force also recommended that clinicians screen for alcohol misuse in adults and offer behavioral counseling interventions in primary care settings to reduce such behavior.
Recommendations by the USPSTF mirror the recommendations by the American Academy of Family Physicians, which also found insufficient evidence to assess benefits and harms of screening for oral cancer, but are at odds with American Cancer Society recommendations advising that adults aged 20 years or older who have periodic health exams should have the oral cavity examined as part of a cancer-related checkup. The American Dental Association recommends that dentists remain alert for signs of potentially malignant lesions or early-stage cancer in patients during routine oral exams, especially for patients using tobacco or partaking in heavy alcohol consumption.