A study published in Cancer Screening and Prevention has analysed approaches to mouth cancer detection. The authors considered the merits of advanced imaging and artificial intelligence in improving prevention strategies.

Cancer is a complex disease characterised by uncontrolled cell growth, significantly impacting global health. Head and neck cancers rank as the sixth most prevalent cancers worldwide.

Oral squamous cell carcinoma (OSCC) is the predominant malignancy in this category, posing a significant health concern due to its high mortality and often late-stage diagnosis. Early detection and appropriate screening measures are pivotal in improving survival rates and reducing the disease burden.

The authors hope that this review will aid in informing detection strategies for underdeveloped and developing nations with “unmet needs”.

Oral cancer overview

Oral cancer involves the malignant growth of cells in the mouth's tissues, including the lips, tongue, gums, cheeks, and throat. The five-year survival rate is low, between 50 per cent and 60 per cent, largely due to late diagnosis.

Early detection is crucial for improving prognosis and survival rates. However, diagnostic delays are common, often attributed to patient-related issues like lack of awareness and delayed consultation, as well as healthcare provider factors such as misdiagnosis or inadequate suspicion of malignancy.

Epidemiology

The global burden of oral cancer is substantial, with approximately 377,713 new cases and 177,757 deaths in 2020, predominantly in Asia.

A 2023 World Health Organisation (WHO) report stated that tobacco smoking and alcohol are the “main drivers of oral cancer in most countries.”

WHO cited specific risk behaviours such as “smokeless tobacco and chewing of areca nut products” as the reasons it believed prevalence in South-central Asia was high.

The authors said that these areas necessitate targeted public health interventions.

Characteristics

Over 90 per cent of oral cancers are OSCCs, often located in the tongue and floor of the mouth. Early-stage carcinomas typically go unnoticed due to the absence of symptoms, leading to late-stage diagnoses characterised by pain, bleeding, and other severe symptoms.

The prognosis is poor once the disease progresses to advanced stages. Early detection relies heavily on clinical examination and biopsy. Recognising the subtle clinical signs in the early stages can significantly alter the treatment outcomes and improve survival rates.

Risk factors

Major risk factors for oral cancer include tobacco use, alcohol consumption, betel quid chewing, and HPV infection. These factors contribute to most oral cancer cases, with synergistic effects observed when multiple risk factors are present.

Other factors include the oral microbiome, chronic mucosal inflammation, and trauma from dental prosthetics. Ultraviolet radiation is a significant risk for lip cancer, while genetic conditions like Xeroderma pigmentosum increase susceptibility.

The study found that public health efforts to reduce these risk factors can significantly decrease the incidence of oral cancer.

Prevention and detection

Prevention strategies have focused on reducing risk factors such as tobacco and alcohol use. Public health campaigns and policy measures targeting these behaviours are crucial for primary prevention.

Secondary prevention has involved screening high-risk populations to detect oral cancer early. Clinical trials in India have shown that reducing tobacco and betel quid use can lower the risk of malignancy. Nutritional interventions with vitamins C, A, and E may also reduce cancer risk.

Regular clinical examinations and biopsies are crucial for early detection, particularly in high-risk areas like the floor of the mouth and the tongue. Implementing community-based screening programs can facilitate early diagnosis and treatment, improving patient outcomes.

Screening techniques

Conventional screening methods have included visual and tactile examinations. However, the authors noted that these have limitations, such as sampling bias.

Visual inspection alone may miss early or subtle lesions. The authors said advanced techniques like imaging and artificial intelligence (AI) may improve accuracy.

Imaging technologies such as autofluorescence, narrow-band imaging, and optical coherence tomography enhance the visualisation of suspicious lesions. AI has shown potential in integrating with conventional methods to enhance early detection and intervention strategies. AI algorithms can analyse large datasets, identify patterns, and assist clinicians in making more accurate diagnoses.

Conclusion

Early detection of oral cancer is critical for improving patient outcomes and reducing mortality. By integrating advanced technologies like imaging and AI with traditional screening methods, the accuracy and effectiveness of early detection can be significantly improved.

This approach is particularly vital for underdeveloped and developing nations, where the burden of oral cancer is highest. Effective screening and prevention strategies can lead to earlier detection, more successful interventions, and better patient prognoses.

Public health policies focusing on education, risk factor modification, and accessible screening programs are essential for combating the high incidence of oral cancer and improving global health outcomes.

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