REVIEW Oral cancer awareness for the general practitioner: new approaches to patient care CS Farah,* MJ McCullough  *Senior Lecturer and Consultant in Oral Medicine and Pathology, School of Dentistry, The University of Queensland, Brisbane.  Associate Professor in Oral Medicine, School of Dental Science, The University of Melbourne, Melbourne. INTRODUCTION There has been a considerable rise in the number of oral cancers worldwide, 1–3 and it is estimated that there are more than 750 000 patients who have oral cancer globally, with 275 000 new cases of oral cancer reported in 2002. 4 Furthermore, survival rates have not dramatically improved in the last few decades, 5 despite advances in therapeutic interventions and our increased understanding of the molecular basis of the disease. In Australia, oral cancer accounts for approximately 2–3 per cent of all cancers, and approximately 1 per cent of deaths from cancer. 6–8 Nationally in 1999, there were 1994 new cases of oral cancer and 365 deaths, 8 while in 2000 there were 2074 new cases and 382 deaths, 7 and in 2001 there were 2090 new cases and 384 deaths. 6 Indeed, over the last two decades, there has been a steady increase in the number of new oral cancer cases reported in Australia, 9 and it is projected that the number of new cases of head and neck cancer will increase between 23 to 28 per cent over the period of 2002–2011. The high rate of oral cancer in Australia is due mainly to lip cancer related to solar irradiation, 4 which has been decreasing slowly over the past decade in men, but increasing slightly in younger women, while the incidence of intra-oral cancer has been gradually increasing. 9 It is now well established that early detection of potentially malignant disease can improve the clinical outcome for patients. Survival rates for oral cancer are very poor at approximately 50 per cent overall, 5 and this is possibly reflected in some part to problems with referrals from primary health care practitioners to specialist centres. 10–12 Recent evidence suggests that general dental practitioners in the United Kingdom had knowledge gaps in their awareness of oral cancer risk factors and the application of preventive measures, 13 although most dental health care providers in the UK did perform visual screening of the oral mucosa for their patients. The aetiology of oral squamous cell carcinoma is predominantly related to tobacco and alcohol con- sumption, however other factors may be involved. Oncogenic viruses such as human papilloma virus, Candida, syphilis, iron deficiency, radiation, immuno- suppression, and oncogenes and tumour-suppressor genes have all been postulated to have a role in the ABSTRACT In Australia, oral cancer accounts for approximately 2–3 per cent of all cancers, and approximately 1 per cent of deaths from cancer. The incidence of intra-oral cancer is gradually increasing. It is now well established that early detection of potentially malignant disease can improve the clinical outcome for patients, and as such it is the responsibility of dentists to identify such lesions early. To facilitate early detection of suspicious oral lesions several clinical methods of detection can be used. In addition to conventional visual screening of oral tissues with the naked eye under projected incandescent or halogen illumination, there are many clinical diagnostic aids that can be undertaken to help detect oral cancer. In this article we explore clinically available modalities that may be used by the general dental practitioner, and highlight their inherent strengths and weaknesses. Key words: Oral cancer, potentially malignant lesions, diagnostic aids, patient care. Abbreviations and acronyms: ALA = aminolaevulinic acid; LOH = loss of heterozygosity. (Accepted for publication 9 July 2007.) Australian Dental Journal 2008; 53: 2–10 doi:10.1111/j.1834-7819.2007.00002.x 2 ª 2008 Australian Dental Association