Twenty-one studies (281,324 participants screened) were included in the analysis on the effectiveness of community-based visual screening for the detection of oral cancer and pre-cancer.
Ten studies (n=4,872) were included in the analysis on the efficacy of adjunctive diagnostic aids to assist visual examination in the diagnosis of oral cancer and pre-cancer.
Community visual screening programmes.
Six studies provided information on the sensitivity of community screening programmes to detect oral cancer or pre-cancer. The sensitivity estimates ranged from 0.71 (specificity 0.99) to 0.94 (specificity 0.98) for screening; a sensitivity estimate of 0.95 for referral was derived from one study. Five studies provided information on the specificity of community screening programmes to detect oral cancer or pre-cancer. The specificity estimates ranged from 0.64 (sensitivity 0.92) to 0.99 (sensitivity 0.71) for screening; a specificity of 0.81 for referral was derived from one study.
Adjunctive techniques.
Toluidine blue, used as either a dye or applied directly to suspicious oral lesions (8 studies): the sensitivity estimates ranged from 0.72 (specificity 0.67) to 1.00 (specificity 0.52), while the specificity estimates ranged from 0.45 (sensitivity 0.86) to 0.93 (sensitivity 0.83 and 0.86).
Visual examination (2 studies): the sensitivity estimates were 0.78 and 0.93, with corresponding specificity estimates of 0.50 and 0.75.
Brush biopsy (1 study): the estimates of sensitivity and specificity were 1.00 and 0.93, respectively.
Lugol's iodine (1 study): the estimates of sensitivity and specificity were 0.88 and 0.84, respectively.
Neural network software (1 study): the estimates of sensitivity and specificity were 0.80 and 0.77, respectively.
Screening augmented by adjunctive techniques. There were insufficient data available to calculate the sensitivity or specificity.