An Automated System Targeting Outpatients at High Risk for Oral Cancer Improves Recruitment to Screening Programs for Premalignant or Early-stage Cancerous Lesions

Subjects A total of 8037 patients (86% male, age 33 to 109 years) attending an outpatient facility at the Far Eastern Memorial Hospital, Taipei, Taiwan, were recruited to the study. All were deemed to be at high risk for oral cancer due to their consumption of tobacco or betel quid. None had a previous diagnosis of oral precancerous or cancerous lesions. Recruitment ran from January 2010 to December 2011. Key Exposure/Study Factor "High-risk" patients at an outpatient facility were identified using an automated system based on their response to questions regarding tobacco and betel nut usage. They were then offered the opportunity to be screened for oral precancerous or cancerous lesions by a member of the Department of Otolaryngology Head and Neck Surgery or Oral Maxillofacial Surgery. The screening consisted of an oral and neck visual examination and palpation of any suspected sites. A comparison was made to patients being referred to the outpatient facility with suspicious oral lesions, which included those with dysplasia and carcinoma. Main Outcome Measure The findings within the screening group were categorized as normal mucosa, benign lesions, or positive lesions. Patients in the positive group underwent a biopsy, with the exception of those diagnosed with homogenous leukoplakia and submucous fibrosis. The biopsied patients and the symptomatic cohort were classified as precancerous (mild, moderate or high dysplasia) or cancerous (squamous cell carcinoma). Main Results One hundred twenty-six of the 8037 asymptomatic outpatients were diagnosed with precancerous or cancerous lesions. Of these, 121 (96%) had precancerous lesions and 5 had squamous cell carcinoma (4%). In the cohort of referred symptomatic patients, 61(28%) patients had precancerous lesions and 157 (72%) had squamous cell carcinoma. Analysis confirmed a statistically significant difference in earlier stage cancers (p < 0.05 by the Fisher exact test) in the outpatient-based automated program. The mean age of the symptomatic cohort was significantly younger (48 +/- 11 years vs 52 +/- 11 years; p < 0.05 by the Mann Whitney test). Conclusions The authors conclude that an outpatient-based screening program makes it possible to identify earlier stage oral cancers. In addition, by taking the risk-based referral decision away from the patient and making the process automated, the recruitment rate is improved, which may reduce oral cancer related morbidity and mortality.