Oral Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Description of the Evidence
Evidence of Harm Associated With Screening
Harms associated with screening for oral cancer are poorly studied in any quantifiable way. However, there are some unavoidable harms that would be associated with routine screening, including:
- Detection of cases that are already incurable, leading to increased morbidity.
- Unnecessary treatment of lesions that would not have progressed (overdiagnosis).
- Psychologic consequences of false-positive tests.
An additional potential harm is misdiagnosis and resulting under- or over-treatment, given the subjective pathology judgments in reading biopsies of oral lesions. When 87 biopsy diagnoses of oral lesions were compared between 21 local pathologists and double-reading by two of three central pathologists in a multicenter study of patients with prior upper aerodigestive tract cancers, agreement was only fair-to-good (kappa weighted-statistic = 0.59; 95% CI, 0.45–0.72). In a bivariate categorization of carcinoma in situ plus carcinoma versus less serious lesions, the agreement was poor, but with very wide CIs (kappa-statistic = 0.39; 95% CI, -0.12–0.97). The investigators in the same study analyzed an agreement between the local and central pathologists on clinically normal tissue adjacent to 67 biopsied clinically-suspicious lesions. The agreement on clinically normal tissue was better than for visibly abnormal lesions, but still not in the excellent range (kappa weighted-statistic = 0.75; 95% CI, 0.64–0.86).
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