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Title In the Primary Care Setting, the Value of Adjunctive Aids for Oral Cancer Examinations Remains Unanswered
Clinical Question Should clinicians use oral cancer adjunctive aids for earlier detection of oral cancer?
Clinical Bottom Line Systematic reviews revealed that there is no evidence to support the use of adjunctive aids for the screening of pre-malignant or malignant oral lesions in a general practice setting. Tissue biopsy remains the gold standard for diagnosis. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18594075Patton/200823 articles compared literature of effectiveness of toluidine blue (TB), ViziLite Plus with TBlue, ViziLite, Microlux DL, Orascoptic DK, VELscope and OralCDx brush biopsy.Systematic Review
Key resultsInsufficient evidence to support or refute the use of visually based examination adjuncts.
#2) 12907211Patton/2003Community based oral cancer screening programs 1966-2002: 36 articlesSystematic Review
Key resultsInsufficient evidence to demonstrate the effectiveness of community-based oral cancer visual screening in enhancing the early detection of oral cancer, due to small effect size.
#3) 21069680Brocklehurst,/2010One RTCSystematic review
Key resultsNo statistical difference in mortality rates was found for the overall population studied when screened, however, a statistically significant higher mortality rate was found by screening of high risk tobacco and or alcohol using persons.
Evidence Search Pubmed: adjunctive oral cancer aids, Limits: Review
Comments on
The Evidence
Both systematic reviews describe a detailed search of relevant articles, and both expressed concern about the lack of high quality definitive research. After Brockelhurst’s analysis of 1,719 studies, only one met the inclusion criteria. The one nine-year RCT reviewed consisted of 191,873 patients and had a high risk of bias.
Applicability At the present time, disciplined visual examination remains the standard for screening for pre-malignant or malignant oral lesions in the primary care setting.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Basic Science)
Keywords oral cancer Screening, Adjunctive aids, Early Detection
ID# 265
Date of submission: 11/11/2009spacer Revised: 11/26/2012
E-mail CookDC@uthscsa.edu
Author Deana Cook, DDS, MS
Co-author(s) e-mail
Faculty mentor/Co-author Micheall A. Huber, DDS
Faculty mentor/Co-author e-mail HuberM@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Matthew Davenport (San Antonio, TX) on 04/12/2012
I conducted a PubMed search on this topic in April 2012 and found a more recent publication supporting your CAT. PubMed ID 20436098 is a meta-analysis done in 2010 supporting that visual examination is still the primary diagnostic tool used and more research is needed on adjunctive aids.

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