Oral Cancer Risk Prediction and Risk-Based Screening Strategies

Oral cancers are promising candidates for screening, early detection, and secondary prevention given the ease in visual inspection, specimen collection, and recognition of precursor lesions (defined as leukoplakia, erythroplakia, and oral submucous fibrosis and histologically based on the grade of dysplasia).

To date, only one randomized trial conducted in Kerala, India has investigated whether visual screening for oral cancer or cancerous precursors reduced oral cancer mortality. This community-based, cluster-randomized trial showed sustained reduction in oral cancer mortality among screened individuals compared to individuals who were not screened, with over 15 years of follow-up. More importantly, the trial showed that the benefit of screening was observed among individuals with traditional oral cancer risk factors—cigarette smokers, tobacco chewers, or alcohol users. These results provide proof-of-principle for risk-based oral cancer screening and suggest that screening efficacy oral cancer varies according to an individual’s baseline risk of oral cancer. However, risk prediction models do not currently exist, despite the strong risk factors for oral cancer (smoking, tobacco, chewing, alcohol use) that collectively account for over 80% of oral cavity cancers worldwide.

To address this gap in the field, the NCI is collaborating with researchers at the International Agency for Research on Cancer (IARC), Regional Cancer Center Trivandrum, and the US Cohort Consortium to develop and validate oral cancer risk prediction models (separate models for populations in India and the United States) and investigate risk-based screening strategies. These efforts aim to: 1) identify a subgroup of individuals at high risk of oral cancer among whom screening would be most beneficial and 2) develop an empirical framework for the introduction of oral cancer screening into high risk populations.

For more information, contact Anil Chaturvedi, Ph.D.