How accurate, clinically effective, and cost-effective are light-based screening techniques for the early detection of oral cancer?
By Lieutenant-Colonel Jean Pierre Picard
Lieutenant-Colonel Jean-Pierre Picard is a Periodontist of the Canadian Armed Forces. He is currently the Deputy Commanding Officer of 1 Dental Unit and the Royal Canadian Dental Corps Periodontics Practice Leader. Lieutenant-Colonel Picard is also an examiner for the National Dental Specialty Examination in Periodontics of the Royal College of Dentists of Canada, the Treasurer of the Canadian Academy of Periodontology (CAP), and the CAP representative to the Canadian Dental Specialties Association.
Dentists are, by way of formal education and expertise, the health care providers best equipped to detect abnormalities of the oral cavity and to provide a comprehensive diagnosis. They have in-depth training in diagnosing an extensive list of ailments affecting the oral cavity and surrounding structures. When considering all the possible diseases and conditions of the oral cavity, cancer is by far the most significant and undesirable diagnosis a dentist can give to a patient. Cognisant of the adverse prognosis of oral cancer and the increased morbidity and mortality associated with delayed diagnosis and treatment of these malignancies, the Royal Canadian Dental Corps has explored the potential of diagnostic aids for early detection of soft tissue abnormalities for our patients.
Fortuitously, the Canadian Agency for Drugs and Technologies in Health (CADTH) has recently put together a systematic appraisal of the existing literature on light-based screening techniques for the detection of oral cancer.
They set out to answer three research questions:
- What is the diagnostic accuracy of light-based screening techniques compared with conventional oral examination for the detection of oral cancer?
- What is the cost-effectiveness of light-based oral cancer screening compared with conventional oral examination?
- What are the evidence-based guidelines for oral cancer screening?
The resulting report, “Screening for Oral Cancer using Light-based Techniques: A Review of the Diagnostic Accuracy, Cost-effectiveness, and Guidelines”, was published on 10 September 2013.
The literature review included two guidelines, two systematic reviews, and 13 primary studies evaluating three light-based screening tools. Their research did not uncover studies which assessed their cost-effectiveness.
It was determined that “the available evidence does not support the use of the evaluated tools for screening of cancer in the general population or those at low risk for malignancy”.
More specifically, the conclusions as they relate to the above questions were:
- When these tools were compared with results from the conventional clinical examination, they did not provide superior diagnostic values.
- No cost-effectiveness studies were found.
- The reviewed light-based screening tools are not suitable for cancer screening in the general population due to their high potential for false positive screening.
- For patients already treated for cancer, light-based screening tools may be helpful as an adjunct tool during the follow-up evaluation.
Based on the current literature and CADTH’s review, the Royal Canadian Dental Corps will continue to use periodic conventional clinical examination for its patient population as the primary method for the early detection of precancerous or cancerous soft tissue oral lesions. However, when a patient has been treated for a soft tissue malignancy, considerations will be made to integrate light-based screening methods to the follow-up examination of those patients. Once a soft tissue lesion has been detected during a conventional clinical examination, consideration may also be made to utilize light-based screening methods as an adjunct in assessing the extent of the lesion for determining the area to be included in the surgical biopsy.
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