Oral cancer screening for asymptomatic adults: do the United States Preventive Services Task Force draft guidelines miss the proverbial forest for the trees?

Abstract

general population 1 . For black men, the results are more discouraging, with a 5 year relative survival of just under 40%. Looking at lifetime risk, a child born today has an estimated 1.1% likelihood of developing oral cavity or pharyngeal cancer at some point during their life 3 . The stage at which the cancer is diagnosed has a significant effect on overall survival. Localized disease, representing disease confined to the primary site, is associated with an 83% 5year survival rate. With spread to the regional lymph nodes, the 5-year survival drops to just under 60%. The statistics are even grimmer in the presence of distant metastasis, with the 5-year survival dropping to 36%. With that backdrop in mind, the United States Preventive Services Task Force (USPSTF) recently released a draft Recommendation Statement which concluded that for adults age 18 years or older seen in the primary care setting, the “current evidence is insufficient to assess the balance of benefits and harms of screening for oral cancer in asymptomatic adults. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.” Rather than representing a paradigm shift, this statement is simply an update of the 2004 USPSTF recommendations, which similarly concluded “there was insufficient evidence to recommend for or against routine screening for oral cancer in adults 4 .” Other expert groups have reached comparable conclusions.