Cochrane · intervention · CD004150
Screening programmes for the early detection and prevention of oral cancer
Brocklehurst, P, Kujan, O, O'Malley, L, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
14
current version
GRADE rated
1
No studies
5
Included studies
1
as reported
No studies 5 · 35.7%Ungraded 8 · 57.1%Very low 0 · 0%Low 1 · 7.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants involved in population, selective (high-risk) or opportunistic screening programmes | Apparently healthy adults aged 35 years or older living in 13 clusters (average 14,759 each) in rural areas of Trivandrum city, Kerala, India. n=191,873. Screening 96,517; control 95,356 |
| Intervention | Any health technology used in a screening programme for detection of oral cancer or PMD: visual screening; visual staining using toluidine blue; oral cytology using brush biopsies; fluorescence imaging and light-based techniques | Visual screening by trained and qualified health workers (n=96517) |
| Comparison | No screening intervention | No screening (n=95356) |
| Outcomes | Oral cancer mortality (primary); incidence of oral cancer or PMD; stage at diagnosis; adverse effects (outcomes from false positive or false negative results, if known); cost data (where reported) | Oral cancer incidence (n=523); Oral cancer mortality (n=292 deaths); Stage at diagnosis (n=523); 5-year survival rate (n=523); Sensitivity (n=1); High-risk subgroup mortality, incidence and stage shift with RR (n=1); Adherence (cycles) subgroup (n=1); Cost-effectiveness (n=1) |
| Study designs | Randomised controlled trials (RCTs) of screening programmes for the early detection of oral cancer or PMD, which report on the associated mortality rates subsequent to the screen | 1 cluster-randomised controlled trial (Trivandrum Oral Cancer Screening Study; Sankaranarayanan 2000; Kerala, India), four screening cycles (n=1) |
| Timing | Not specified | 15 years follow up (four screening cycles) |
Search date: 22 July 2013. Databases: The Cochrane Oral Health Group's Trials Register (to 22 July 2013); CENTRAL (The Cochrane Library 2013 Issue 6); MEDLINE via OVID (1946 to 22 July 2013); EMBASE via OVID (1980 to 22 July 2013); CANCERLIT via PubMed (1950 to 22 July 2013)
Questions and results
Show all 4 versionsVisual screening (oral visual inspection) by trained health workers vs No screening
Population: Apparently healthy adults aged 35 years or older (general population), living in 13 clusters in rural areas of Trivandrum city, Kerala, India
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral cancer mortality (disease-specific) 15-year follow-up | RR 0.88 [0.69, 1.12] | 1 study · 191873 participants | Low Downgraded: risk of bias |
Costs 9 years (three cycles) | The costs associated with the screening programme were reported after three cycles (nine years) (Subramanian 2009) (Additional Table 8). The benefit produced by a screen was 269.31 life-years saved per 100,000 for all… | 1 study | Ungraded |
Harms of screening (false-positive/false-negative outcomes) 15-year follow-up | No harms were reported. | 0 studies | No studies |
Quality of life 15-year follow-up | Data on quality of life were not reported. | 0 studies | No studies |
Oral cancer incidence 15-year follow-up | RR 1.14 [0.91, 1.44] | 1 study · 191873 participants | Ungraded |
Test performance (sensitivity and specificity) 15-year follow-up | Across the four cycles (15 years), the reported sensitivity of the visual examination in detecting oral cancer was 67.4% (188/279). No information on the specificity or the positive predictive value of the programme… | 1 study | Ungraded |
Stage at diagnosis (early-stage detection) 15-year follow-up | RR 0.81 [0.70, 0.93] | 1 study · 523 participants | Ungraded |
Stage at diagnosis (early-stage detection) 15-year follow-up · High-risk individuals (tobacco and/or alcohol users) | RR 0.82 [0.71, 0.95] | 1 study · 486 participants | Ungraded |
Survival (proportion alive after diagnosis) 5-year survival | A significantly higher five-year survival rate was reported in the screened group (55.5%) compared to the control (43.4%) (P value = 0.003). | 1 study · 523 participants | Ungraded |
Oral cancer mortality (disease-specific) 15-year follow-up · High-risk individuals (tobacco and/or alcohol users) | RR 0.76 [0.60, 0.97] | 1 study | Ungraded |
Oral cancer incidence 15-year follow-up · High-risk individuals (tobacco and/or alcohol users) | RR 0.97 [0.79, 1.19] | 1 study | Ungraded |
Toluidine blue (visual staining) vs No screening
Population: Planned population: general population or high-risk / opportunistic screening groups (no eligible study)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There was no evidence to support the use of adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging as a screening tool to reduce oral cancer mortality; no eligible randomised controlled trial… | 0 studies | No studies |
Fluorescence imaging / light-based techniques vs No screening
Population: Planned population: general population or high-risk / opportunistic screening groups (no eligible study)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There was no evidence to support the use of adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging as a screening tool to reduce oral cancer mortality; no eligible randomised controlled trial… | 0 studies | No studies |
Brush biopsy (oral cytology) vs No screening
Population: Planned population: general population or high-risk / opportunistic screening groups (no eligible study)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There was no evidence to support the use of adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging as a screening tool to reduce oral cancer mortality; no eligible randomised controlled trial… | 0 studies | No studies |