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ADA unveils oral cancer EBD recommendations

ADA News

May 13, 2010

ADA unveils oral cancer EBD recommendations

By Jennifer Garvin

A panel convened by the ADA Council on Scientific Affairs explored the potential benefits and risks of screening for oral squamous cell carcinomas and the use of screening aids to detect malignant or potentially malignant oral lesions. The panel's findings are published as the cover story in the May edition of The Journal of the American Dental Association.

"Evidence-Based Clinical Recommendations Regarding Screening for Oral Squamous Cell Carcinomas" were developed by a CSA expert panel convened in April 2009, and join similar recommendations on topical fluoride and sealants as the Association's only evidence-based recommendations.

Four questions considered in EBD oral cancer effort

In developing the evidence-based clinical recommendations for oral squamous cell carcinomas, the ADA Council on Scientific Affairs considered the following questions:

Does screening through visual and tactile examination performed by a dentist reduce morbidity and mortality resulting from potentially malignant or malignant lesions?
Does the use of the following adjuncts (autofluorescence, tissue reflectance and transepithelial cytology) by a dentist, in conjunction with visual and tactile examination, reduce morbidity and mortality from oral cancer to a greater extent than that experienced with visual and tactile examination alone?
In comparison with visual and tactile examination alone, do the currently available oral cancer detection devices enhance the diagnostic properties (such as sensitivity, specificity, positive and negative predictive values) in detection of potentially malignant or malignant lesions?
Are there specific population subgroups—defined by age, sex, ethnicity, risk factors or other characteristics—in which oral cancer screening has relatively high positive and negative predictive values, resulting in detection of potentially malignant or malignant oral lesions?

Though EBD recommendations do not represent a standard of care, the CSA hopes practitioners will use the recommendations as a resource in their clinical decision-making process alongside a clinician’s judgment and experience in the context of a patient's individual needs.

The panel worked with ADA Center for Evidence-Based Dentistry staff and assessed five systematic reviews and four clinical studies as a basis for developing the recommendations. They addressed whether or not screenings help reduce morbidity and mortality, and whether or not oral cancer detection devices aid in detecting potentially malignant or malignant lesions.

The panel concluded that while oral cancer screenings may detect potentially malignant and/or malignant lesions, clinicians are urged to remain alert for signs the lesions may become cancerous or early stage cancers while performing routine visual and tactile examinations in all patients, particularly those who use tobacco or consume alcohol heavily.

"What's most important is that this (review) points to the need for more research on the natural history of squamous cell carcinomas in the mouth and the epidemiology of oral cancer," said Dr. Michael Rethman, CSA chair. "We still don't understand the answers to a lot of fundamental questions like the progression of the disease and whether intervention helps. It's plausible that early diagnosis helps, but we don't even know that," he added.

"There's an incredible need for more research on this topic," he added.

For more information about the ADA's clinical recommendations, visit http://ebd.ada.org.

To see the May issue of JADA, go to http://jada.ada.org.

And for information about an ADA-sponsored CE course at this year's annual session, see ADA plans oral cancer CE course for Orlando.

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