Farina Francesca, Cirillo Nicola
Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC 3010, Australia.
STEMM Research, Liverpool L3 8HY, UK.
Cancers (Basel). 2024 Dec 8;16(23):4110. doi: 10.3390/cancers16234110.
Screening is widely believed to facilitate early detection and improve health outcomes; however, recent evidence questions its overall benefits, highlighting the need for a critical assessment of cancer screening programs. The simplicity of clinical oral examination and the easy accessibility of the oral cavity make oral cancer a suitable candidate for opportunistic screening. Despite this uniqueness, studies that solidly assess the efficacy and cost-effectiveness of oral cancer screening are scanty, and the only large randomized trial undertaken so far shows limited evidence of mortality reduction through population screening. Research indicates that while early detection rates following screening may increase, they do not necessarily translate into decreased oral cancer deaths. This article emphasizes the need for a nuanced understanding of the benefits of screening, awareness of deceptive metrics and inherent biases in the context of early detection, and the importance of improving dentist education and introducing new technologies to enhance clinical decision-making. The review calls for a balanced and evidence-based approach to oral cancer screening, integrating it with broader oral health initiatives to maximize public health outcomes.
人们普遍认为筛查有助于早期发现并改善健康结果；然而，最近的证据对其整体益处提出了质疑，强调需要对癌症筛查项目进行批判性评估。临床口腔检查的简便性以及口腔的易于接近性使得口腔癌成为机会性筛查的合适对象。尽管具有这种独特性，但扎实评估口腔癌筛查效果和成本效益的研究却很少，迄今为止进行的唯一一项大型随机试验显示，通过人群筛查降低死亡率的证据有限。研究表明，虽然筛查后的早期发现率可能会提高，但这并不一定会转化为口腔癌死亡人数的减少。本文强调需要对筛查的益处有细致入微的理解，意识到早期发现背景下具有误导性的指标和内在偏差，以及提高牙医教育水平和引入新技术以加强临床决策的重要性。该综述呼吁采取平衡且基于证据的方法进行口腔癌筛查，并将其与更广泛的口腔健康倡议相结合，以实现公共卫生成果最大化。
