The U.S. Preventive Services Task Force (USPSTF) has reaffirmed its position on screening for oral cancer in asymptomatic adults(www.uspreventiveservicestaskforce.org), issuing a draft recommendation statement that indicates current evidence remains insufficient to assess the balance of benefits and harms of testing.
This indurated enlargement of the ventral tongue shows an associated ulcer that later was diagnosed as squamous cell carcinoma. Photo courtesy of Michael Finkelstein, Gilbert Lilly and Hardin Health Sciences Library, University of Iowa.
Specifically, a lack of evidence regarding the following three aspects of screening precluded task force members from making an overall recommendation:
- Can the oral cancer screening exam detect oral cancer accurately?
- Can screening for oral cancer and treating screen-detected oral cancer improve morbidity or mortality?
- What are the harms of screening?
Family physician and USPSTF member Mark Ebell, M.D., of Athens, Ga., who also serves as deputy editor of American Family Physician, says family physicians should continue to evaluate thoroughly all adult patients who complain of oral lesions but notes that the evidence does not support routine testing for those who have no such symptoms.
- The U.S. Preventive Services Task Force has issued a draft statement indicating that current evidence is insufficient to assess the balance of benefits and harms of screening for oral cancer in asymptomatic adults.
- Family physicians should continue to evaluate thoroughly all adult patients who complain of oral lesions.
- More research on oral cancer screening in the primary care setting is needed, with a special focus on human papillomavirus-related oral cancer.
"For patients who are asymptomatic, the evidence is insufficient to recommend that family physicians spend time routinely screening them," says Ebell. "As is the case for many conditions, we need more research in the primary care setting to answer this question (of whether to screen patients with no symptoms), especially since HPV (human papillomavirus) is emerging as an important risk factor for oral cancer."
Although as much as 75 percent of oral cancer cases can be attributed to tobacco and alcohol use, data suggest the number of such cases is beginning to decline. On the other hand, there was a threefold increase in HPV-related oral cancer cases documented from 1998 to 2004.
According to the USPSTF draft statement, the current prevalence of oral HPV infection in the United States is estimated to be nearly 7 percent in people ages 14-69 years but is thought to increase to as much as 20 percent for a subset of people who have had 20 or more sexual partners in their lifetime or who use tobacco at a rate of more than one pack of cigarettes per day.
"The prevalence of type-specific HPV-16 is 1 percent in adults ages 14 to 69 years (an estimated 2.13 million infected individuals)," says the draft statement. "HPV-16 accounts for at least 90 percent of all HPV-related cancer cases. Therefore, the rising role of HPV oral infection as a risk factor for oral cancer may warrant future assessment of the independent effect of HPV-16 on incidence and outcomes of oral cancer and the effects of screening individuals who are positive for HPV-16."
The USPSTF currently recommends that family physicians and other health professionals screen all adults for tobacco use, recommend against its use and provide tobacco cessation interventions for those who use tobacco products. The task force also recommends the use of screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse by adults.
The draft recommendation statement is available for comment until May 6 at 5 p.m. EDT.
The AAFP Commission on Health of the Public and Science is reviewing the USPSTF draft recommendation and evidence report and will comment on the draft statement and make recommendations to the Academy's Board of Directors regarding any indicated changes in current AAFP policy.