Kujan O, Glenny A M, Oliver R J, Thakker N, Sloan P
School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, UK M15 6FH.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004150. doi: 10.1002/14651858.CD004150.pub2.
Screening programmes for major cancers, such as breast and cervical cancer have effectively decreased the mortality rate and helped to reduce the incidence of these cancers. Although oral cancer is a global health problem with increasing incidence and mortality rates, no national population-based screening programmes for oral cancer have been implemented. To date there is debate on whether to employ screening methods for oral cancer in the daily routine work of health providers.
To assess the effectiveness of current screening methods in decreasing oral cancer mortality.
Electronic databases (MEDLINE, CANCERLIT, EMBASE, the Cochrane Central Register of Controlled Trials; 1966 to July 2005, The Cochrane Library - Issue 3, 2005), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data.
Randomised controlled trials of screening for oral cancer or precursor oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy.
The search found 112 citations and these have been reviewed. One randomised controlled trial of screening strategies for oral cancer was identified as meeting the review's inclusion criteria. Validity assessment, data extraction and statistics evaluation were undertaken by two independent review authors.
One 10-year randomised controlled trial has been included (n = 13 clusters: 191,873 participants). There was no difference in the age-standardised oral cancer mortality rates for the screened group (16.4/100,000 person-years) and the control group (20.7/100,000 person-years). Interestingly, a significant 34% reduction in mortality was recorded in high-risk subjects between the intervention cohort (29.9/100,000 person-years) and the control arm (45.4/100,000). However, this study has some methodological weaknesses. Additionally, the study did not provide any information related to costs, quality of life or even harms of screening from false-positive or false-negative findings.
AUTHORS' CONCLUSIONS: Given the limitation of evidence (only one included randomised controlled trial) and the potential methodological weakness of the included study, it is valid to say that there is insufficient evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest that other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Future high quality studies to assess the efficacy, effectiveness and costs of screening are required for the best use of public health resources. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed. Future studies on improved treatment modalities for oral cancer and precancer are also required.
乳腺癌和宫颈癌等主要癌症的筛查项目有效降低了死亡率，并有助于减少这些癌症的发病率。尽管口腔癌是一个全球健康问题，其发病率和死亡率都在上升，但尚未实施基于全国人口的口腔癌筛查项目。迄今为止，对于在医疗服务提供者的日常工作中是否采用口腔癌筛查方法存在争议。
评估当前筛查方法在降低口腔癌死亡率方面的有效性。
使用电子数据库（MEDLINE、CANCERLIT、EMBASE、Cochrane对照试验中心注册库；1966年至2005年7月，Cochrane图书馆 - 2005年第3期）、参考文献目录、对特定期刊的手工检索以及与作者联系，以识别已发表和未发表的数据。
使用视觉检查、甲苯胺蓝、荧光成像或刷检对口腔癌或口腔癌前病变进行筛查的随机对照试验。
检索到112条引文并进行了审查。确定了一项符合综述纳入标准的口腔癌筛查策略随机对照试验。由两位独立的综述作者进行有效性评估、数据提取和统计学评价。
纳入了一项为期10年的随机对照试验（n = 13个群组：191,873名参与者）。筛查组（16.4/100,000人年）和对照组（20.7/100,000人年）的年龄标准化口腔癌死亡率没有差异。有趣的是，在高风险受试者中，干预队列（29.9/100,000人年）和对照组（45.4/100,000）之间的死亡率显著降低了34%。然而，这项研究存在一些方法学上的弱点。此外，该研究没有提供任何与成本、生活质量甚至假阳性或假阴性结果导致的筛查危害相关的信息。
鉴于证据有限（仅纳入一项随机对照试验）以及纳入研究潜在的方法学弱点，可以说没有足够的证据支持或反驳在普通人群中使用视觉检查作为口腔癌筛查方法。此外，没有有力证据表明其他筛查方法，如甲苯胺蓝、荧光成像或刷检，是有益还是有害。需要未来进行高质量研究以评估筛查的疗效、有效性和成本，以便最佳利用公共卫生资源。此外，需要开展研究以阐明口腔癌的自然史、预防方法以及高危人群机会性筛查的有效性。还需要对口腔癌和癌前病变的改进治疗方式进行未来研究。
