Study designs of evaluations included in the review
Prospective clinical studies were eligible for inclusion in the review.
Specific interventions included in the review
Studies that assessed screening for cancer or pre-cancer, and which involved an examination of the oral mucosa and defined criteria for a positive screen, were included. The personnel carrying out the screening included GDPs (not defined but likely to be General Dental Practitioners), hospital and general dentists, and health workers. Screening programmes were both pilot and definitive. Recruitment procedures were by invitation, opportunistic or through case finding. In some studies the personnel were not specifically trained. Screening was carried out in dental surgeries, health centres, hospitals and the participants' homes. Details of the conditions targeted were reported. In some studies only individuals whose test results had been verified using the 'gold' standard were included in the review.
Reference standard test against which the new test was compared
Studies that used, as the reference standard, examination by an expert of participants that screened positive were eligible for inclusion. At least a proportion of individuals with a negative index test result had to receive the reference standard. Reference standards were not reported clearly but appeared to be clinical examination by dental health professionals such as oral medicine specialists, specialist oral surgeons, physicians, university-based dentists and project dentists. Reference standard examinations were carried out in dental surgeries, health centres, hospitals, the participants' homes and referral centres.
Participants included in the review
No inclusion criteria relating to the participants were specified, but the review appeared to have been restricted to studies that screened healthy individuals. The categories of people screened in the included studies were company HQ staff, eligible adults, general practice patients, hospital visitors, high-risk adults and general adult populations. The studies were carried out in England, Japan, India and Sri Lanka. All studies included both men and women aged 20 years or older. In the included studies, the lesion prevalence in verified patients ranged from 1.4 to 50.7%.
Outcomes assessed in the review
The studies had to report sufficient data to construct a 2x2 table of test performance to be included. The primary outcomes reported in the review were the sensitivity and specificity.
How were decisions on the relevance of primary studies made?
One reviewer reviewed titles and abstracts, and those that were deemed to be of no relevance were excluded from further consideration. The full text of all remaining articles was obtained for detailed review by two independent reviewers. Any disagreements were resolved through consensus.