 |
| 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) 18594075 | Patton/2008 | 23 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 results | Insufficient evidence to support or refute the use of visually based examination adjuncts. | | #2) 12907211 | Patton/2003 | Community based oral cancer screening programs 1966-2002: 36 articles | Systematic Review | | Key results | Insufficient 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) 21069680 | Brocklehurst,/2010 | One RTC | Systematic review | | Key results | No 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: |
11/11/2009 Revised: 11/26/2012 |
| E-mail |
CookDC@uthscsa.edu |
| Author |
Deana Cook, DDS, MS |
| Co-author(s) |
|
| 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
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
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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