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Oral Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Description of the Evidence

Background

Incidence and mortality

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An estimated 41,380 new cases of oral cancer will be diagnosed in the United States in 2013, and an estimated 7,890 people will die of the disease.[1] This form of cancer accounts for about 3% of cancers in men.[1] The overall annual incidence in the United States is about 10.8 per 100,000 men and women; the median age at diagnosis of oral cavity or pharyngeal cancer was 62 years from 2005 to 2009.[2]

Incidence has been falling in men since 1975 and in women since 1980. However, incidence has recently been increasing for oral cancers related to human papillomavirus (HPV) infection. About 60% of oral/pharyngeal cancers are moderately advanced (regional stage) or metastatic at the time of diagnosis.[1]

The estimated annual worldwide number of incident oral cancers is about 275,000, with an approximately 20-fold variation geographically.[3] South and Southeast Asia (India, Sri Lanka, Pakistan, and Bangladesh), France, and Brazil have particularly high rates. In most countries, men have higher rates of oral cancer than women (due to tobacco use) and higher rates of lip cancer (due to sunlight exposure from outdoor occupations).[3]

Risk factors

The primary risk factors for oral cancer in American men and women are tobacco (including smokeless tobacco) and alcohol use. Infection with HPV-16 has been associated with an excess risk of developing squamous cell carcinoma of the oropharynx.[4]

Evidence of Benefit Associated With Screening

No population-based screening programs for oral cancers have been implemented in developed countries, although opportunistic screening or screening as part of a periodic health examination has been advocated.[5,6] There are different methods of screening for oral cancers. Oral cancer occurs in a region of the body that is generally accessible to physical examination by the patient, the dentist, and the physician; and visual examination is the most common method used to detect visible lesions. Other methods have been used to augment clinical detection of oral lesions and include toluidine blue, brush biopsy, and fluorescence staining.

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