Asian Paciic Journal of Cancer Prevention, Vol 14, 2013 3369 DOI:http://dx.doi.org/10.7314/APJCP.2013.14.5.3369 Dilemmas of Oral Cancer Screening - an Update Asian Paciic J Cancer Prev, 14 (5), 3369-3373 Introduction Head and neck cancer is a global health burden with high mortality and morbidity. It has been ranked as the sixth most common cancer worldwide with over 650,000 new cases with 50% associated deaths each year (Warnakulasuriya, 2009; Ferlay et al., 2010). Five-year survival rates exceed 50% in only the best treatment centres. Causes are predominantly lifestyle-related: tobacco, areca nut, alcohol, poor diet, viral infections, and pollution are all important etiological factors (Johnson et al., 2011). Late-stage diagnosis, ield of cancerisation and second primary tumors were considered to play a major role in the poor prognosis of oral cancer (Seoane-Romero et al., 2012). The ight to reduce oral cancer mortality can be accomplished on three different levels: (i) primary prevention; (ii) secondary prevention, screening and early detection; (iii) improved treatment. Early detection and screening has shown to be effective in reducing mortality and morbidity of most common cancers. Screening has been defined as a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition (Epstein et al., 2008). Another 1 Department of Oral Medicine and Diagnostic Sciences, School of Dentistry, Al-Farabi College, Riyadh, Kingdom of Saudi Arabia, 2 Department of Oral Pathology, School of Dentistry, Al-Baath University, Hama, Syria, 3 School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK *For correspondence: omar.kujan@gmail.com Abstract Oral cancer is a global health burden with high mortality and morbidity. Advances in treatment have failed to improve the relatively poor survival rate due to late-stage diagnosis. Early detection and screening have been shown to be effective in reducing mortality and morbidity of most common cancers. Several studies have evaluated the effectiveness of oral cancer screening programs but clear results were not obtained. This narrative commentary aimed to give a critical insight into the dilemma of oral cancer screening and to suggest recommendations for future trends. Conventional oral examination still constitutes the gold standard screening tool for potentially malignant oral lesions and cancer. Interestingly, the indings of the most lasting (15-year) randomized controlled trial on oral cancer screening using visual examination (Kerala) supported the introduction of a screening program in high-risk individuals. Several screening adjuncts exist but are still not at the introduction stage. Further research to ind an appropriate adjunct reliable tool for oral cancer screening is needed. In conclusion, oral cancer fulills most of the essential principles of cancer screening but still many points need to be clariied. Therefore, there is a striking need to establish a global consortium on oral cancer screening that will oversee research and provide recommendations for health authorities at regular intervals. Keywords: Oral - cancer - screening - diagnostic aids COMMENTARY Dilemmas of Oral Cancer Screening: An Update Omar Kujan 1,2 *, Philip Sloan 3 interesting deinition is early detection and diagnosis, achieved by surveillance and secondary prevention (Tyagi et al., 2012). Screening for oral cancer implies searching for oral potentially malignant and cancerous lesions, typically before symptoms occur. A number of established cancer screening programs for a variety of malignancies have been shown to signiicantly reduce patient morbidity and mortality - including the Pap test for cervical cancer and mammography for breast cancer. Unlike other major cancers, screening program of oral cancer, either as a targeted, opportunistic or population based measure, is still has not been inaugurated to the routine health services as its effectiveness remains a pivotal question that needs a deinitive answer. We aimed in this perspective to give critical insight into the dilemma of oral cancer screening and to suggest recommendations for future trends. The latest update of the ongoing Cochrane systematic review on the effectiveness of oral cancer concluded that “although there is evidence that a visual examination as part of a population based screening programme reduced the mortality rate of oral cancer in high-risk individuals, whilst producing a stage shift and improvement in survival rates across the population as a whole, the evidence is limited to one study and is associated with a high risk of bias. This was compounded by the fact that the effect of cluster randomisation was not accounted for in the analysis.