REVIEW ARTICLE Oral Medicine Screening for oral cancer: contributing to the debate Saman Warnakulasuriya & Nathalie Cain Department of Oral and Maxillofacial Medicine, King’s College London Dental Institute, London, UK Introduction As it stands, being born and raised in England is likely to subject an individual to approximately 12 assessments for screening programs in their lifetime. Whether the general population is aware of this or not, facts and figures about their sex, age, family, ethnicity, and medical history are continually processed to see whether they are to be placed in an ‘‘at-risk’’ population for a multitude of diseases and conditions stretching across abdominal aortic aneurysms to diabetic retinopathy, and bowel, breast, or cervical can- cer. ‘‘Screening’’, even just as a term, is controversial; it conceals, unintentionally, ethical debates, issues of false positives and negatives, and their consequences. Many professionals now prefer the term ‘‘case detection’’, which contextualizes screening programs for what they are: the process of identifying apparently healthy people who might be at increased risk of a disease or condition. By definition, those identified as at risk can be offered information, further tests, and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition. 1 In light of the recognized impact of screening on those people highlighted as at risk for a particular disease or condition, proposed screening programs are forced to meet stringent criteria before being considered for nation- wide application. These criteria encompass an in-depth level of knowledge of the condition or disease in question, to include the natural history of the disease, its epidemiol- ogy, and to an extent, etiology. They also call for a simple, precise, and validated screening test, and an effective treatment or intervention in the advent of a positive test. In 1968, Wilson and Jungner 2 first defined these crite- ria, and until recently, their work withstood the test of time. With the dawn of a new era in technological advancement, particularly in terms of imaging technology and advancements in the field of genomics and proteo- mics and the mapping of the genome, the health-care Keywords cancer, criteria, oral, precancer, screening. Correspondence Prof. Saman Warnakulasuriya, Department of Oral and Maxillofacial Medicine, King’s College London Dental Institute, Bessemer Road, Denmark Hill, London SE5 9RW, UK. Tel: +44-020-3299-2430 Fax: +44-020-3299-3624 Email: s.warne@kcl.ac.uk Received 16 September 2010; accepted 22 September 2010. doi: 10.1111/j.2041-1626.2010.00040.x Abstract Screening, or ‘‘case detection’’, is controversial and central to much debate in the world of medicine. In the present study, we evaluate oral cancer screening against the National (UK) Screening Committee criteria in the context of the most recent research in this field. Oral cancer is a complex, debilitating disease that is increasing in incidence in the UK and in most parts of Western Europe. It has multifactorial etiology, and these major risk factors are well researched, allowing definition of an ‘‘at-risk’’ population. However, our understanding of its natural history of progression from potentially malignant disorders to malignancy is limited; the field lacks high-quality, randomized, controlled trials, bar one published study. Evidence is also available to suggest that visual screen- ing by sufficiently trained examiners results in earlier detection (down staging) of the disease, which lends itself towards more successful treatment. Sensitive screening tools to aid and confirm findings following a visual inspection are yet to be developed. Nevertheless, new tests continue to arise based on knowl- edge gleaned from research into the biomarkers. This review discusses the evidence based around the oral cancer screening debate and highlights areas in which more research is required before the advent of a successful and effective screening program. Journal of Investigative and Clinical Dentistry (2011), 2, 2–9 2 ª 2011 Blackwell Publishing Asia Pty Ltd