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</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Oral Cavity and Nasopharyngeal Cancers Screening (PDQ®): Health Professional Version</div><div class="j">PDQ Cancer Information Summaries [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 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id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK65776_"><span class="title" itemprop="name">Oral Cavity and Nasopharyngeal Cancers Screening (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contribs">PDQ Screening and Prevention Editorial Board.</p><p class="fm-aai"><a href="#_NBK65776_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062752__86">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about oral cavity and nasopharyngeal cancers screening. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062752__87">This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062752__1"><h2 id="_CDR0000062752__1_"> Overview</h2><p id="CDR0000062752__91">Oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancers may be referred to as head and neck squamous cell cancers. Oral cavity squamous cell cancers most commonly arise from the mucosal surfaces lining the oral cavity. Pharyngeal squamous cell cancers can be categorized into nasopharyngeal, oropharyngeal, and hypopharyngeal cancers on the basis of anatomical landmarks. <a class="figpopup" href="/books/NBK65776/figure/CDR0000062752__217/?report=objectonly" target="object" rid-figpopup="figCDR0000062752217" rid-ob="figobCDR0000062752217">Figure 1</a> shows the anatomy of the pharynx.</p><div id="CDR0000062752__217" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201&p=BOOKS&id=602812_CDR0000713970.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65776/bin/CDR0000713970.jpg" alt="Anatomy of the pharynx; drawing shows the nasopharynx, oropharynx, and hypopharynx. Also shown are the nasal cavity, oral cavity, hyoid bone, larynx, esophagus, and trachea." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Figure 1. Anatomy of the pharynx.</p></div></div><p id="CDR0000062752__2">Note: The Overview section summarizes the published evidence on this topic. The rest of the summary describes the evidence in more detail.</p><p id="CDR0000062752__244">Other PDQ summaries on <a href="/books/n/pdqcis/CDR0000062837/?report=reader">Oral Cavity, Oropharyngeal, Hypopharyngeal, and Laryngeal Cancers Prevention</a> and <a href="/books/n/pdqcis/CDR0000062930/?report=reader">Lip and Oral Cavity Cancer Treatment</a> are also available.</p><div id="CDR0000062752__48"><h3>Benefits</h3><p id="CDR0000062752__49">There is inadequate evidence to establish whether screening would result in a
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decrease in mortality from oral cavity and nasopharyngeal cancers.</p><p id="CDR0000062752__50"><b>Magnitude of Effect</b>: No evidence of benefit, and harms have not been quantified.</p><ul id="CDR0000062752__51" class="simple-list"><li class="half_rhythm"><div>
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<b>Study Design</b>: Evidence obtained from one randomized controlled trial and observational studies.</div></li><li class="half_rhythm"><div><b>Internal Validity</b>: Poor.</div></li><li class="half_rhythm"><div><b>Consistency</b>: Not applicable (N/A).</div></li><li class="half_rhythm"><div><b>External Validity</b>: Poor.</div></li></ul></div><div id="CDR0000062752__52"><h3>Harms</h3><p id="CDR0000062752__53">Harms, although unavoidable, have not been quantified on the basis of the literature. However, there are some unavoidable harms that would be associated with routine screening, including:</p><ul id="CDR0000062752__74"><li class="half_rhythm"><div>Unnecessary treatment associated with overdiagnosis.</div></li><li class="half_rhythm"><div>Psychological consequences of false-positive tests.</div></li><li class="half_rhythm"><div>Misdiagnosis because of variability in assessment of biopsies.</div></li></ul><p id="CDR0000062752__54"><b>Magnitude of Effect</b>: Unknown.</p><ul id="CDR0000062752__55" class="simple-list"><li class="half_rhythm"><div>
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<b>Study Design</b>: Observational studies.</div></li><li class="half_rhythm"><div><b>Internal Validity</b>: Poor.</div></li><li class="half_rhythm"><div><b>Consistency</b>: N/A.</div></li><li class="half_rhythm"><div><b>External Validity</b>: Poor.</div></li></ul></div></div><div id="CDR0000062752__57"><h2 id="_CDR0000062752__57_">Incidence and Mortality</h2><p id="CDR0000062752__58">An estimated 58,450 new cases of oral cavity and oropharynx cancers will be diagnosed in
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the United States in 2024, and an estimated 12,230 people will die of these
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diseases.[<a class="bibr" href="#CDR0000062752_rl_57_1" rid="CDR0000062752_rl_57_1">1</a>]
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The overall annual incidence in the United States is about 11 cases per 100,000 men and women; the incidence rate is highest in individuals aged 75 to 84 years.[<a class="bibr" href="#CDR0000062752_rl_57_2" rid="CDR0000062752_rl_57_2">2</a>]</p><p id="CDR0000062752__59"> Since the mid-2000s, incidence rates increased by about 1% per year.[<a class="bibr" href="#CDR0000062752_rl_57_1" rid="CDR0000062752_rl_57_1">1</a>] The incidence has been increasing for oral cavity and oropharyngeal cancers related to human papillomavirus (HPV) infection. About 60% of oral/pharyngeal cancers are moderately advanced (regional stage) or metastatic at the time of diagnosis.[<a class="bibr" href="#CDR0000062752_rl_57_2" rid="CDR0000062752_rl_57_2">2</a>] The 5-year relative survival rate is 69%.[<a class="bibr" href="#CDR0000062752_rl_57_1" rid="CDR0000062752_rl_57_1">1</a>]</p><p id="CDR0000062752__62">The estimated annual worldwide number of incidents of oral cavity and oropharyngeal cancers is about 275,000, with an approximate 20-fold variation geographically.[<a class="bibr" href="#CDR0000062752_rl_57_3" rid="CDR0000062752_rl_57_3">3</a>] South and Southeast Asia (India, Sri Lanka, Pakistan, and Bangladesh), France, and Brazil have particularly high rates. In most countries, men have higher rates of oral cavity cancer than women (caused by tobacco use) and higher rates of lip cancer (caused by sunlight exposure from outdoor occupations).[<a class="bibr" href="#CDR0000062752_rl_57_3" rid="CDR0000062752_rl_57_3">3</a>]</p><p id="CDR0000062752__102">Nasopharyngeal cancers are rare in the United States, with an annual incidence rate of 0.7 cases per 100,000 persons.[<a class="bibr" href="#CDR0000062752_rl_57_4" rid="CDR0000062752_rl_57_4">4</a>] However, there are marked geographic differences, with an overall incidence in China that is 40- to 380-fold higher than that in the United States.[<a class="bibr" href="#CDR0000062752_rl_57_4" rid="CDR0000062752_rl_57_4">4</a>] There are elevated rates of nasopharyngeal cancers in the Cantonese population of southern China (including Hong Kong), and intermediate rates are observed in several indigenous populations in Southeast Asia and in natives of the Arctic region, North Africa, and the Middle East. First-generation Chinese immigrants to the United States maintain a high incidence rate, while their descendants born in the United States show a decreased incidence. The 5-year survival rate for keratinizing squamous cell carcinoma, the most common subtype of nasopharyngeal cancer in the United States, is 46%.[<a class="bibr" href="#CDR0000062752_rl_57_5" rid="CDR0000062752_rl_57_5">5</a>]</p><div id="CDR0000062752_rl_57"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062752_rl_57_1">American Cancer Society: Cancer Facts and Figures 2024. American Cancer Society, 2024. <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed December 30, 2024.</div></li><li><div class="bk_ref" id="CDR0000062752_rl_57_2">Surveillance Research Program, National Cancer Institute: SEER*Explorer: An interactive website for SEER cancer statistics. Bethesda, MD: National Cancer Institute. <a href="https://seer.cancer.gov/statistics-network/explorer/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed December 30, 2024.</div></li><li><div class="bk_ref" id="CDR0000062752_rl_57_3">Warnakulasuriya S: Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 45 (4-5): 309-16, 2009 Apr-May. [<a href="https://pubmed.ncbi.nlm.nih.gov/18804401" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18804401</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_57_4">Richey LM, Olshan AF, George J, et al.: Incidence and survival rates for young blacks with nasopharyngeal carcinoma in the United States. Arch Otolaryngol Head Neck Surg 132 (10): 1035-40, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/17043247" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17043247</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_57_5">Ou SH, Zell JA, Ziogas A, et al.: Epidemiology of nasopharyngeal carcinoma in the United States: improved survival of Chinese patients within the keratinizing squamous cell carcinoma histology. Ann Oncol 18 (1): 29-35, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17060483" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17060483</span></a>]</div></li></ol></div></div><div id="CDR0000062752__73"><h2 id="_CDR0000062752__73_">Risk Factors</h2><p id="CDR0000062752__60">The primary risk factors for oral cavity cancers in American men and women are tobacco
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(including smokeless tobacco) use, alcohol use, betel-quid chewing, and human papillomavirus infection (HPV).</p><p id="CDR0000062752__95">Risk factors for nasopharyngeal cancer include Epstein-Barr virus (EBV) persistent infection.[<a class="bibr" href="#CDR0000062752_rl_73_1" rid="CDR0000062752_rl_73_1">1</a>]</p><p id="CDR0000062752__96">For more information about factors associated with an increased or decreased risk of oral cavity squamous cell cancers, see <a href="/books/n/pdqcis/CDR0000062837/?report=reader">Oral Cavity, Oropharyngeal, Hypopharyngeal, and Laryngeal Cancers Prevention</a> and <a href="/books/n/pdqcis/CDR0000062930/?report=reader">Lip and Oral Cavity Cancer Treatment</a>.</p><div id="CDR0000062752__234"><h3>Epstein-Barr Virus (EBV) Infection </h3><p id="CDR0000062752__235">Based on solid evidence, EBV infection causes nasopharyngeal cancer in high-incidence areas.[<a class="bibr" href="#CDR0000062752_rl_73_1" rid="CDR0000062752_rl_73_1">1</a>] Collective evidence includes numerous case-control studies and cohort studies that show a higher proportion of patients with nasopharyngeal cancer who have anti-EBV antibodies than controls and that seropositive status precedes tumor diagnosis.[<a class="bibr" href="#CDR0000062752_rl_73_2" rid="CDR0000062752_rl_73_2">2</a>,<a class="bibr" href="#CDR0000062752_rl_73_3" rid="CDR0000062752_rl_73_3">3</a>] Recent studies have also found circulating cell-free EBV DNA in patients with nasopharyngeal cancer but not in controls.[<a class="bibr" href="#CDR0000062752_rl_73_4" rid="CDR0000062752_rl_73_4">4</a>] EBV alone is not a sufficient cause because 90% of adults worldwide are infected with the virus, but only a small proportion develop nasopharyngeal cancer.[<a class="bibr" href="#CDR0000062752_rl_73_5" rid="CDR0000062752_rl_73_5">5</a>] EBV infection is subclinical and occurs early in childhood. The pathogenesis is thought to involve the virus establishing latency in epithelial cells that have already undergone premalignant genetic changes.</p><p id="CDR0000062752__236">One of the first studies to show an association was a cohort study that found higher anti-EBV titers in 84% of the 235 East African and Chinese patients with nasopharyngeal carcinoma.[<a class="bibr" href="#CDR0000062752_rl_73_2" rid="CDR0000062752_rl_73_2">2</a>,<a class="bibr" href="#CDR0000062752_rl_73_5" rid="CDR0000062752_rl_73_5">5</a>] The same study found higher anti-EBV titers with higher-stage tumor, and a case-control component of the study revealed that high anti-EBV titers were six times more likely in patients with nasopharyngeal carcinoma than in patients with head and neck cancers at other sites.</p><p id="CDR0000062752__237">Other studies show elevation in both IgG and IgA antibody titers to EBV viral capsid antigen and other latent viral antigens, which precede tumor development by several years and are correlated with tumor burden, remission, and recurrence.[<a class="bibr" href="#CDR0000062752_rl_73_2" rid="CDR0000062752_rl_73_2">2</a>,<a class="bibr" href="#CDR0000062752_rl_73_3" rid="CDR0000062752_rl_73_3">3</a>] A large cohort study with 9,699 men measured both IgA antibodies against EBV capsid antigen and neutralizing antibodies against EBV-specific DNase and followed them for a later diagnosis of nasopharyngeal cancer.[<a class="bibr" href="#CDR0000062752_rl_73_3" rid="CDR0000062752_rl_73_3">3</a>] The relative risk of nasopharyngeal carcinoma was 32.8 for individuals with both antibody markers (95% confidence interval [CI], 7.3–147.2; <i>P</i> < .001), and 4.0 for individuals with one marker (95% CI, 1.6–10.2; <i>P</i> = .003), compared with individuals with neither marker. There was a temporal relationship in that the difference in cumulative incidence between seropositive and seronegative patients increased with a longer duration of follow-up. Another study found circulating cell-free EBV DNA in 95% of patients with advanced nasopharyngeal cancer but not in controls or cured patients.[<a class="bibr" href="#CDR0000062752_rl_73_4" rid="CDR0000062752_rl_73_4">4</a>]</p></div><div id="CDR0000062752_rl_73"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062752_rl_73_1">IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: Biological agents. Volume 100 B. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum 100 (Pt B): 1-441, 2012. [<a href="/pmc/articles/PMC4781184/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4781184</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23189750" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23189750</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_73_2">Henle W, Henle G, Ho HC, et al.: Antibodies to Epstein-Barr virus in nasopharyngeal carcinoma, other head and neck neoplasms, and control groups. J Natl Cancer Inst 44 (1): 225-31, 1970. [<a href="https://pubmed.ncbi.nlm.nih.gov/11515035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11515035</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_73_3">Chien YC, Chen JY, Liu MY, et al.: Serologic markers of Epstein-Barr virus infection and nasopharyngeal carcinoma in Taiwanese men. N Engl J Med 345 (26): 1877-82, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11756578" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11756578</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_73_4">Lin JC, Wang WY, Chen KY, et al.: Quantification of plasma Epstein-Barr virus DNA in patients with advanced nasopharyngeal carcinoma. N Engl J Med 350 (24): 2461-70, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15190138" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15190138</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_73_5">Chang ET, Adami HO: The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev 15 (10): 1765-77, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/17035381" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17035381</span></a>]</div></li></ol></div></div><div id="CDR0000062752__64"><h2 id="_CDR0000062752__64_">Evidence of Benefit Associated With Screening </h2><p id="CDR0000062752__61">No population-based screening programs for oral cavity squamous cell cancers have been implemented in developed countries, although opportunistic screening or screening as part of a periodic health examination has been advocated for the oral cavity, which is the only site accessible without endoscopy.[<a class="bibr" href="#CDR0000062752_rl_64_1" rid="CDR0000062752_rl_64_1">1</a>,<a class="bibr" href="#CDR0000062752_rl_64_2" rid="CDR0000062752_rl_64_2">2</a>]</p><div id="CDR0000062752__97"><h3>Screening for Oral Cavity Cancers</h3><p id="CDR0000062752__98">There are different methods of screening for oral cavity cancers. Oral cavity cancers occur in a region of the body that is generally accessible to physical examination by the patient, the dentist, and the physician; and visual examination is the most common method used to detect visible lesions. Other methods have been used to augment clinical detection of oral lesions and include toluidine blue, brush biopsy, and fluorescence staining.</p><p id="CDR0000062752__63"> An inspection of the oral cavity is often part of a physical examination in a dentist's or physician's office. Of note, high-risk individuals visit their medical doctors more
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frequently than they visit their dentists. Although physicians are more likely to provide risk-factor counseling (such as tobacco cessation), they are less likely than dentists to perform an oral cancer examination.[<a class="bibr" href="#CDR0000062752_rl_64_3" rid="CDR0000062752_rl_64_3">3</a>] Overall, only a fraction (~20%) of Americans receive an oral cancer examination. Black patients, Hispanic patients, and those who have a lower level of education are less likely to have such an examination, perhaps because they lack access to medical care.[<a class="bibr" href="#CDR0000062752_rl_64_3" rid="CDR0000062752_rl_64_3">3</a>] An
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oral examination often includes looking for leukoplakia and erythroplakia
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lesions, which can progress to cancer.[<a class="bibr" href="#CDR0000062752_rl_64_4" rid="CDR0000062752_rl_64_4">4</a>,<a class="bibr" href="#CDR0000062752_rl_64_5" rid="CDR0000062752_rl_64_5">5</a>] One study has shown that direct fluorescence visualization (using a simple hand-held device in the operating room) could identify subclinical high-risk fields with cancerous or precancerous changes extending up to 25 mm beyond the primary tumor in 19 of 20 patients undergoing oral surgery for invasive or <i>in situ</i> squamous cell tumors.[<a class="bibr" href="#CDR0000062752_rl_64_6" rid="CDR0000062752_rl_64_6">6</a>] However, this finding has not yet been tested in a screening setting. Data suggest that molecular
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markers may be useful in the prognosis of these premalignant oral
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lesions.[<a class="bibr" href="#CDR0000062752_rl_64_7" rid="CDR0000062752_rl_64_7">7</a>]</p><p id="CDR0000062752__65">The routine examination of asymptomatic and symptomatic patients can lead to detection of earlier-stage cancers and premalignant lesions. There is no definitive evidence, however, to show that this screening can reduce oral cancer mortality, and there are no randomized controlled trials (RCTs) in any Western or other low-risk populations.[<a class="bibr" href="#CDR0000062752_rl_64_5" rid="CDR0000062752_rl_64_5">5</a>,<a class="bibr" href="#CDR0000062752_rl_64_8" rid="CDR0000062752_rl_64_8">8</a>-<a class="bibr" href="#CDR0000062752_rl_64_11" rid="CDR0000062752_rl_64_11">11</a>]</p><p id="CDR0000062752__66">In a single RCT of screening versus usual care, 13 geographic clusters in the Trivandrum district of Kerala, India, were randomly assigned to receive systematic oral visual screening by trained health workers (seven screened clusters, six control clusters) every 3 years for four screening rounds between 1996 and 2008. During a 15-year follow-up period, there were 138 deaths from oral cancer in the screening group, with a cause-specific mortality rate of 15.4 per 100,000 person-years, and 154 deaths in the control group, with a mortality rate of 17.1 per 100,000 person-years (relative risk [RR], 0.88; 95% confidence interval [CI], 0.69–1.12). In a subset analysis restricted to tobacco or alcohol users, the mortality rates were 30 and 39 per 100,000 person-years, respectively (RR, 0.76; 95% CI, 0.60–0.97). There was no apparent adjustment of the CIs for the cluster design. In another subgroup analysis, mortality hazard ratios were calculated for groups defined by number of times screened, but the inappropriate comparison in each case was to the control group of the whole study. No data on treatment of oral cancers were presented.[<a class="bibr" href="#CDR0000062752_rl_64_12" rid="CDR0000062752_rl_64_12">12</a>-<a class="bibr" href="#CDR0000062752_rl_64_15" rid="CDR0000062752_rl_64_15">15</a>]</p><p id="CDR0000062752__67">Aside from the issues of generalizability to other populations and lack of an overall statistically significant result in cause-specific mortality, interpretation of the results is made difficult by serious lacks in methodological detail about the randomization process, allocation concealment, adjustment for clustering effect, and information about treatment. The total number of clusters randomized was small, and there were different distributions of income and household possessions between the two study arms. Withdrawals and dropouts were not clearly described. In summary, the sole randomized trial does not provide solid evidence of a cause-specific mortality benefit associated with systematic oral cavity visual examination.</p><p id="CDR0000062752__76">Techniques such as toluidine blue staining, brush biopsy/cytology, or fluorescence imaging as the primary screening tool or as an adjunct for screening have not been shown to have superior sensitivity and specificity for visual examination alone or to yield better health outcomes.[<a class="bibr" href="#CDR0000062752_rl_64_5" rid="CDR0000062752_rl_64_5">5</a>,<a class="bibr" href="#CDR0000062752_rl_64_16" rid="CDR0000062752_rl_64_16">16</a>] In an RCT conducted in Keelung County, Taiwan, 7,975 individuals at high risk of oral cancer due to cigarette smoking or betel-quid chewing were randomly assigned to receive a one-time oral cancer examination after gargling with toluidine blue or a blue placebo dye.[<a class="bibr" href="#CDR0000062752_rl_64_17" rid="CDR0000062752_rl_64_17">17</a>] The positive test rates were 9.5% versus 8.3%, respectively (<i>P</i> = .047). The detection of premalignant lesions was not statistically different (rate ratio, 1.05; 95% CI, 0.74–1.41). The number of overall oral cancers diagnosed within the short follow-up period of 5 years was too small for valid comparison (six in each group).</p><p id="CDR0000062752__69">The operating characteristics of the various techniques used as an adjunct to oral visual examination are not well established. A systematic literature review of toluidine blue, a variety of other visualization adjuncts, and cytopathology in the screening setting revealed a very broad range of reported sensitivities, specificities, and positive predictive values when biopsy confirmation was used as the gold standard outcome.[<a class="bibr" href="#CDR0000062752_rl_64_18" rid="CDR0000062752_rl_64_18">18</a>] In part, this range of findings can be attributed to varying study populations, sample size and settings, and criteria for positive-clinical examinations and for scoring a biopsy as positive.</p></div><div id="CDR0000062752__99"><h3>Screening for Nasopharyngeal Cancer</h3><p id="CDR0000062752__100">Serum Epstein-Barr virus (EBV)–associated antibodies and circulating cell-free EBV DNA testing have been used for nasopharyngeal cancer diagnosis and screening. In an observational study of 20,349 men aged 40 to 62 years, circulating cell-free EBV DNA testing was used to screen for nasopharyngeal cancer.[<a class="bibr" href="#CDR0000062752_rl_64_19" rid="CDR0000062752_rl_64_19">19</a>,<a class="bibr" href="#CDR0000062752_rl_64_20" rid="CDR0000062752_rl_64_20">20</a>] A total of 1.5% of participants tested positive twice for EBV DNA and had further workup, leading to a diagnosis of nasopharyngeal cancer for 34 patients. The EBV DNA test had a sensitivity of 97.1% (95% CI, 95.5%–98.7%) and specificity of 98.6% (95% CI, 98.6%–98.7%). Without a control group, the study compared stage of disease at diagnosis with a historical cohort and found a higher proportion of stage I and stage II disease (71% vs. 20%; <i>P</i> < .001) and superior 3-year progression-free survival in the screen-detected population. However, the survival benefit in the study may also be caused by lead-time bias. </p><p id="CDR0000062752__101">Other screening programs in southern China use EBV-associated antibodies, but their effects are difficult to determine because of lack of controls for comparison of survival outcomes.[<a class="bibr" href="#CDR0000062752_rl_64_20" rid="CDR0000062752_rl_64_20">20</a>-<a class="bibr" href="#CDR0000062752_rl_64_22" rid="CDR0000062752_rl_64_22">22</a>] In summary, current screening studies for nasopharyngeal cancer do not provide solid evidence of a benefit associated with screening for nasopharyngeal cancer, especially in nonendemic regions such as the United States.</p></div><div id="CDR0000062752_rl_64"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062752_rl_64_1">Opportunistic oral cancer screening: a management strategy for dental practice. BDA Occasional Paper 6: 1-36, 2000. <a href="https://www.researchgate.net/publication/281307136_Opportunistic_oral_cancer_screening" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed April 12, 2024.</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_2">Smith RA, Cokkinides V, Brooks D, et al.: Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 61 (1): 8-30, 2011 Jan-Feb. [<a href="https://pubmed.ncbi.nlm.nih.gov/21205832" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21205832</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_3">Kerr AR, Changrani JG, Gany FM, et al.: An academic dental center grapples with oral cancer disparities: current collaboration and future opportunities. J Dent Educ 68 (5): 531-41, 2004. [<a href="/pmc/articles/PMC1409711/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1409711</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15186070" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15186070</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_4">Warnakulasuriya S, Johnson NW, van der Waal I: Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 36 (10): 575-80, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17944749" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17944749</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_5">Brocklehurst P, Kujan O, Glenny AM, et al.: Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev (11): CD004150, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/21069680" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21069680</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_6">Poh CF, Zhang L, Anderson DW, et al.: Fluorescence visualization detection of field alterations in tumor margins of oral cancer patients. Clin Cancer Res 12 (22): 6716-22, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/17121891" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17121891</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_7">Poh CF, Zhang L, Lam WL, et al.: A high frequency of allelic loss in oral verrucous lesions may explain malignant risk. Lab Invest 81 (4): 629-34, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11304582" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11304582</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_8">Screening for oral cancer. In: Fisher M, Eckhart C, eds.: Guide to Clinical Preventive Services: an Assessment of the Effectiveness of 169 Interventions. Report of the U.S. Preventive Services Task Force. Williams & Wilkins, 1989, pp 91-94.</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_9">Antunes JL, Biazevic MG, de Araujo ME, et al.: Trends and spatial distribution of oral cancer mortality in São Paulo, Brazil, 1980-1998. Oral Oncol 37 (4): 345-50, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11337266" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11337266</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_10">U.S. Preventive Services Task Force: Screening for Oral Cancer: Recommendation Statement. Rockville, Md: U.S. Preventive Services Task Force, 2013. <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/oral-cancer-screening1" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed April 12, 2024.</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_11">Scattoloni J: Screening for Oral Cancer: Brief Evidence Update. Rockville, Md: U.S. Preventive Services Task Force, 2004. <a href="https://www.uspreventiveservicestaskforce.org/home/getfilebytoken/bNvmg937mA6ks3n448uEUD" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed April 12, 2024.</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_12">Sankaranarayanan R, Mathew B, Jacob BJ, et al.: Early findings from a community-based, cluster-randomized, controlled oral cancer screening trial in Kerala, India. The Trivandrum Oral Cancer Screening Study Group. Cancer 88 (3): 664-73, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10649262" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10649262</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_13">Ramadas K, Sankaranarayanan R, Jacob BJ, et al.: Interim results from a cluster randomized controlled oral cancer screening trial in Kerala, India. Oral Oncol 39 (6): 580-8, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/12798401" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12798401</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_14">Sankaranarayanan R, Ramadas K, Thomas G, et al.: Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial. Lancet 365 (9475): 1927-33, 2005 Jun 4-10. [<a href="https://pubmed.ncbi.nlm.nih.gov/15936419" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15936419</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_15">Sankaranarayanan R, Ramadas K, Thara S, et al.: Long term effect of visual screening on oral cancer incidence and mortality in a randomized trial in Kerala, India. Oral Oncol 49 (4): 314-21, 2013. [<a href="https://pubmed.ncbi.nlm.nih.gov/23265945" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23265945</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_16">Lingen MW, Kalmar JR, Karrison T, et al.: Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 44 (1): 10-22, 2008. [<a href="/pmc/articles/PMC2424250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2424250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17825602" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17825602</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_17">Su WW, Yen AM, Chiu SY, et al.: A community-based RCT for oral cancer screening with toluidine blue. J Dent Res 89 (9): 933-7, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20525960" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20525960</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_18">Patton LL, Epstein JB, Kerr AR: Adjunctive techniques for oral cancer examination and lesion diagnosis: a systematic review of the literature. J Am Dent Assoc 139 (7): 896-905; quiz 993-4, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18594075" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18594075</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_19">Chan KCA, Woo JKS, King A, et al.: Analysis of Plasma Epstein-Barr Virus DNA to Screen for Nasopharyngeal Cancer. N Engl J Med 377 (6): 513-522, 2017. [<a href="https://pubmed.ncbi.nlm.nih.gov/28792880" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28792880</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_20">Cao SM, Simons MJ, Qian CN: The prevalence and prevention of nasopharyngeal carcinoma in China. Chin J Cancer 30 (2): 114-9, 2011. [<a href="/pmc/articles/PMC4013340/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4013340</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21272443" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21272443</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_21">Zeng Y, Zhang LG, Li HY, et al.: Serological mass survey for early detection of nasopharyngeal carcinoma in Wuzhou City, China. Int J Cancer 29 (2): 139-41, 1982. [<a href="https://pubmed.ncbi.nlm.nih.gov/6895884" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6895884</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_64_22">Zeng Y, Zhong JM, Li LY, et al.: Follow-up studies on Epstein-Barr virus IgA/VCA antibody-positive persons in Zangwu County, China. Intervirology 20 (4): 190-4, 1983. [<a href="https://pubmed.ncbi.nlm.nih.gov/6317603" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6317603</span></a>]</div></li></ol></div></div><div id="CDR0000062752__70"><h2 id="_CDR0000062752__70_">Evidence of Harm Associated With Screening</h2><p id="CDR0000062752__71">Harms associated with screening for oral cavity squamous cell cancers are poorly studied in any quantifiable way.[<a class="bibr" href="#CDR0000062752_rl_70_1" rid="CDR0000062752_rl_70_1">1</a>] However, there are some unavoidable harms that would be associated with routine screening, including:</p><ul id="CDR0000062752__77"><li class="half_rhythm"><div>Unnecessary treatment of lesions that would not have progressed (overdiagnosis).</div></li><li class="half_rhythm"><div>Psychological consequences of false-positive tests.[<a class="bibr" href="#CDR0000062752_rl_70_2" rid="CDR0000062752_rl_70_2">2</a>]</div></li></ul><p id="CDR0000062752__72">An additional potential harm is misdiagnosis and resulting under- or overtreatment, given the subjective pathology judgments in the reading of biopsies of oral lesions. When 87 biopsy diagnoses of oral lesions were compared between 21 local pathologists and double-reading by two of three central pathologists in a multicenter study of patients with prior upper aerodigestive tract cancers, agreement was only fair to good (kappa-weighted statistic, 0.59; 95% confidence interval [CI], 0.45–0.72).[<a class="bibr" href="#CDR0000062752_rl_70_3" rid="CDR0000062752_rl_70_3">3</a>] In a bivariate categorization of carcinoma <i>in situ</i> plus carcinoma versus less serious lesions, the agreement was poor, but with very wide CIs (kappa statistic, 0.39; 95% CI, -0.12 to -0.97). The investigators in the same study analyzed an agreement between the local and central pathologists on clinically normal tissue adjacent to 67 biopsied, clinically suspicious lesions. The agreement on clinically normal tissue was better than for visibly abnormal lesions, but still not in the excellent range (kappa-weighted statistic, 0.75; 95% CI, 0.64–0.86).[<a class="bibr" href="#CDR0000062752_rl_70_4" rid="CDR0000062752_rl_70_4">4</a>]</p><div id="CDR0000062752_rl_70"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062752_rl_70_1">Scattoloni J: Screening for Oral Cancer: Brief Evidence Update. Rockville, Md: U.S. Preventive Services Task Force, 2004. <a href="https://www.uspreventiveservicestaskforce.org/home/getfilebytoken/bNvmg937mA6ks3n448uEUD" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed April 12, 2024.</div></li><li><div class="bk_ref" id="CDR0000062752_rl_70_2">Speight PM, Zakrzewska J, Downer MC: Screening for oral cancer and precancer. Eur J Cancer B Oral Oncol 28B (1): 45-8, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1422471" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1422471</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_70_3">Fischer DJ, Epstein JB, Morton TH, et al.: Interobserver reliability in the histopathologic diagnosis of oral pre-malignant and malignant lesions. J Oral Pathol Med 33 (2): 65-70, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/14720191" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14720191</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062752_rl_70_4">Fischer DJ, Epstein JB, Morton TH, et al.: Reliability of histologic diagnosis of clinically normal intraoral tissue adjacent to clinically suspicious lesions in former upper aerodigestive tract cancer patients. Oral Oncol 41 (5): 489-96, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15878753" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15878753</span></a>]</div></li></ol></div></div><div id="CDR0000062752__17"><h2 id="_CDR0000062752__17_">Latest Updates to This Summary (04/12/2024)</h2><p id="CDR0000062752__19">The PDQ cancer information summaries are reviewed regularly and updated as
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new information becomes available. This section describes the latest
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changes made to this summary as of the date above.</p><p id="CDR0000062752__241">
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<b>
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<a href="#CDR0000062752__57">Incidence and Mortality</a>
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</b>
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</p><p id="CDR0000062752__242">Updated <a href="#CDR0000062752__58">statistics</a> with estimated new cases and deaths for 2024 (cited American Cancer Society as reference 1).</p><p id="CDR0000062752__243">Revised <a href="#CDR0000062752__59">text</a> to state that since the mid-2000s, incidence rates increased by about 1% per year. The 5-year relative survival rate is 69%.</p><p id="CDR0000062752__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/screening-prevention" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Screening and Prevention Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000062752__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® Cancer Information for Health Professionals</a> pages.
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</p></div><div id="CDR0000062752__AboutThis_1"><h2 id="_CDR0000062752__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062752__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062752__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about oral cavity and nasopharyngeal cancers screening. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062752__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062752__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/screening-prevention" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Screening and Prevention Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062752__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062752__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062752__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p id="CDR0000062752__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062752__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062752__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a <a href="/books/n/pdqcis/CDR0000304747/?report=reader">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062752__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062752__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062752__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062752__AboutThis_15">PDQ® Screening and Prevention Editorial Board. PDQ Oral Cavity and Nasopharyngeal Cancers Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/head-and-neck/hp/oral-screening-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/head-and-neck/hp/oral-screening-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389219]</p><p id="CDR0000062752__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062752__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062752__AboutThis_19">The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062752__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062752__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div><div style="display:none"><div style="display:none" id="figCDR0000062752217"><img alt="Image CDR0000713970" src-large="/books/NBK65776/bin/CDR0000713970.jpg" /></div></div></div></div><div class="fm-sec"><h2 id="_NBK65776_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">PDQ Screening and Prevention Editorial Board</span>.</p><h3>Publication History</h3><p class="small">Published online: April 12, 2024.</p><h3>Version History</h3><ul class="simple-list" style="padding:0"><li><span class="bk_col_itm">NBK65776.18</span> April 12, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65776.17/?report=reader">NBK65776.17</a></span> May 22, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65776.16/?report=reader">NBK65776.16</a></span> April 29, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65776.15/?report=reader">NBK65776.15</a></span> November 3, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65776.14/?report=reader">NBK65776.14</a></span> October 15, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65776.13/?report=reader">NBK65776.13</a></span> October 8, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65776.12/?report=reader">NBK65776.12</a></span> June 15, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65776.11/?report=reader">NBK65776.11</a></span> June 11, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65776.10/?report=reader">NBK65776.10</a></span> March 30, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65776.9/?report=reader">NBK65776.9</a></span> February 5, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65776.8/?report=reader">NBK65776.8</a></span> February 27, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65776.7/?report=reader">NBK65776.7</a></span> April 4, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65776.6/?report=reader">NBK65776.6</a></span> March 29, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65776.5/?report=reader">NBK65776.5</a></span> February 9, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65776.4/?report=reader">NBK65776.4</a></span> January 19, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65776.3/?report=reader">NBK65776.3</a></span> March 17, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65776.2/?report=reader">NBK65776.2</a></span> April 1, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65776.1/?report=reader">NBK65776.1</a></span> July 22, 2015</li></ul><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>PDQ Screening and Prevention Editorial Board. Oral Cavity and Nasopharyngeal Cancers Screening (PDQ®): Health Professional Version. 2024 Apr 12. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="fig" id="figobCDR0000062752217"><div id="CDR0000062752__217" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201&p=BOOKS&id=602812_CDR0000713970.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK65776/bin/CDR0000713970.jpg" alt="Anatomy of the pharynx; drawing shows the nasopharynx, oropharynx, and hypopharynx. Also shown are the nasal cavity, oral cavity, hyoid bone, larynx, esophagus, and trachea." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Figure 1. Anatomy of the pharynx.</p></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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