Oral Cancer Screening

Many people notice sores or lumps in their throat or mouth but do not seek medical attention. This is partly due to the nature of these symptoms and their mimicking by benign conditions, and also because patients do not recognise them themselves.


Early diagnosis improves survival. Many oral cancers have a premalignant phase accessible to visual inspection and can be detected by opportunistic screening.

What is oral cancer screening?

Screenings are used to detect pre-cancerous changes in the mouth before they become cancer. They can be performed by your dentist or other healthcare provider, and are usually quick and painless. During a screening, your provider will rinse your mouth and shine a light in your mouth. Healthy tissues in the mouth will take up the light and look dark while abnormal cells appear white.

If a screening shows an area of concern, further testing will be needed to determine if it is cancerous or not. This includes a biopsy which involves removing a small sample of the tissue and sending it to a lab for analysis. The most effective way to prevent oral cancer is to quit smoking or using smokeless tobacco and reduce heavy alcohol consumption. Regular dental checkups and professional cleanings can also help to prevent these problems.

In the low/middle income countries where health care workers are scarce, several population-based oral cancer/OPMD screening models have been developed. A review of the literature identifies many strengths and weaknesses of these programs. Some of the potential directions for future research include developing a risk prediction model, implementing mobile technology to capture and send clinical images, introducing telemedicine for consultation with experts, and increasing compliance to referral.

What are the symptoms of oral cancer?

The most common symptom is a painless lump in the mouth that doesn’t go away. This may be accompanied by other symptoms like difficulty swallowing, chewing or talking, and a persistent sore in the mouth that won’t heal. If you have these symptoms, it is important to see your doctor as early as possible so that oral cancer can be diagnosed and treated if present.

A GP or dentist will ask you about your symptoms and examine your mouth. If they think you may have oral cancer, they will refer you to a specialist doctor, usually within 2 weeks. You might be referred to an oral and maxillofacial surgeon or a head and neck specialist.

These doctors will carefully examine your mouth using a mirror and a bright light. They will check for any areas that have changed and if they find any, they will take a sample of the tissue to test it for cancer cells. This is called case finding. It is not a screening test and will not find every cancer. The main benefit of case finding is that it reduces death rates because cancers are found when they are less advanced and easier to treat.

The most common risk factors for developing oral cancer are tobacco and alcohol use, and in the very back of the mouth (oropharynx) a genetic predisposition in some people and the human papilloma virus (HPV). Even though HPV-related oral cancers are rare, they can be just as deadly as cancers caused by other causes.

What are the risk factors for oral cancer?

Aging, tobacco and alcohol use, poor dental hygiene, and the presence of asymptomatic precancerous lesions all increase the risk for developing oral cancer. Other risk factors include infections (such as herpes simplex virus) and inherited conditions that can predispose to cancer (such as Fanconi anemia and dyskeratosis congenital). In addition, certain inflammatory diseases, such as periodontitis, can cause lesions in the mouth that could lead to cancer.

The US Preventive Services Task Force has concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral cancer in asymptomatic adults. Although the current evidence is sparse, the task force recommends that individuals consult with their healthcare provider about whether a screening test may be right for them.

Studies of oral cancer screening have used house-to-house visits, invitational screening at dental practices or other community settings, integrating with general health screening programs, and self-screening (Table 1). Most studies show that high attendance rates are essential for the success of any screening program. In addition, the ability to quickly refer and confirm a screen-positive case is vital for optimizing the program’s benefits.

The 2 principal benefits of cancer screening are to detect cases at a more curable stage and reduce death and morbidity. The natural history of oral cancer suggests that screening can achieve both objectives. However, differences in the natural histories of different types of oral squamous cell carcinoma (OSCC) and OPMDs can distort these results. “Aggressive” OSCCs progress rapidly (hence their steep curve) and are unlikely to be detected during screening. By contrast, “indolent” OSCCs progress more slowly (hence their flatter curve) and often transform to invasive cancer, but they can be captured by screening.

What is the treatment for oral cancer?

Oral cancer may be treated with surgery to remove the tumor, radiation therapy to destroy any remaining cancer cells and/or chemotherapy (drug treatments) to control any symptoms. Treatment is most effective if it is given at an early stage, so it is important to go for regular screenings and have a prompt diagnosis when any abnormalities are found.

A small number of mouth cancers spread to lymph nodes in the neck. Your doctor will examine the lymph nodes and tissue around the site of the original tumour to check for the presence of other tumours. If the cancer is found in the lymph nodes, your doctor may take samples from them to be examined under a microscope and to determine the grade of your cancer (low, moderate or high).

Some cancers never cause any symptoms or become life-threatening. If these cancers are detected by a screening test, they may be treated even though they would not have caused any problems if left untreated. This is called overdiagnosis.

Different types of cancers respond to different treatments. Your doctor will recommend a treatment plan after examining you and discussing your symptoms. In some cases, a multidisciplinary team of specialists will make the treatment decision. These teams often include head and neck surgeons, radiation oncologists and medical oncologists, and a speech-language pathologist.