Oral Cancer Screening: Past, Present, and Future.
Oral Cancer Screening: Past, Present, and Future.
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DOI：
10.1177/00220345211014795
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发表时间：
2021-11
影响因子：
7.6
通讯作者：
Kerr AR
中科院分区：
文献类型：
--
作者：
Warnakulasuriya S;Kerr AR
口腔癌是一个重大的公共卫生问题，青年男女患口腔癌的趋势越来越明显。公众意识差，许多患者出现晚期疾病，导致高死亡率。口腔癌之前通常有一个肉眼可见的临床癌前期，因此有机会早期发现并降低发病率和死亡率。通过系统的视觉口腔检查来筛查无症状个体以发现疾病已被证明是可行的。阳性筛查包括口腔癌和口腔潜在恶性疾病。我们回顾了进行的关键筛选研究，包括1项随机临床试验。对高危人群进行筛查具有成本效益。口腔癌筛查研究的优势和劣势被提出，以帮助指导初级保健环境中的新研究，并被使用新兴技术的前景所鼓舞，这些新技术可能有助于提高病例检测的歧视性准确性。迄今为止，包括美国预防服务工作组在内的大多数国家组织都不建议进行基于人群的筛查，因为缺乏足够的证据表明筛查可以降低口腔癌死亡率。在卫生保健资源丰富的地方，建议在牙科实践中进行机会性筛查，尽管初级保健研究的缺乏令人震惊。调查结果表明，牙医确实会进行口腔癌筛查，但只有微弱的证据表明，在牙科实践中进行筛查会降低疾病的分期。在卫生保健资源匮乏的地方，已经对使用初级卫生保健工作者进行口腔癌筛查的可行性进行了测试，结果表明效果良好。文献中报道的大多数研究都是基于一轮筛查，而筛查应该是一个持续的过程。本综述指出了口腔癌筛查的新研究方向的巨大潜力。
Oral cancer is a major public health problem, and there is an increasing trend for oral cancer to affect young men and women. Public awareness is poor, and many patients present with late-stage disease, contributing to high mortality. Oral cancer is often preceded by a clinical premalignant phase accessible to visual inspection, and thus there are opportunities for earlier detection and to reduce morbidity and mortality. Screening asymptomatic individuals by systematic visual oral examinations to detect the disease has been shown to be feasible. A positive screen includes both oral cancer and oral potentially malignant disorders. We review key screening studies undertaken, including 1 randomized clinical trial. Screening of high-risk groups is cost-effective. Strengths and weaknesses of oral cancer screening studies are presented to help guide new research in primary care settings and invigorated by the prospect of using emerging new technologies that may help to improve discriminatory accuracy of case detection. Most national organizations, including the US Preventive Services Task Force, have so far not recommended population-based screening due a lack of sufficient evidence that screening leads to a reduction in oral cancer mortality. Where health care resources are high, opportunistic screening in dental practices is recommended, although the paucity of research in primary care is alarming. The results of surveys suggest that dentists do perform oral cancer screenings, but there is only weak evidence that screening in dental practices leads to downstaging of disease. Where health care resources are low, the feasibility of using primary health care workers for oral cancer screening has been tested, and measures indicate good outcomes. Most studies reported in the literature are based on 1 round of screening, whereas screening should be a continuous process. This review identifies a huge potential for new research directions on screening for oral cancer.