Jullien, Josephine Anne; (1996) Evaluation of aspects of screening for oral cancer. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Evidence suggests that early detection of oral cancer or precancer decreases both mortality and morbidity. Screening for oral cancer may be an effective health care intervention in view of the annual increase in new registrations of oral cancer and rising mortality rates. Oral cancer meets many of the criteria for a disease suitable for screening, however a need exists for research into the design of a screening programme and the validity of a screening test. Visual examination of the oral mucosa would appear to be a valid instrument for detecting oral cancer and precancer; in this study a selection of qualified dentists achieved this with a sensitivity and specificity of 0.74 and 0.99 respectively. Compliance from an invitational screening programme was disappointingly low (25.7%) compared to other similar programmes suggesting that targeting of high risk individuals may be more effective in detecting lesions. Data from the screened population was modified and used to train a computerised neural network, this was shown to be a useful tool for the identification of people at high risk from oral cancer and could detect lesions with sensitivity (0.80) and specificity (0.77), values comparable to dentists. Health care interventions such as screening programmes are assessed in terms of costs and benefits to the patient and public. Quality of life was compared in terms of utility values between patients treated for small oral cancers and those treated for more major cancers. Utility values for various stages of oral cancer were also obtained from a sample of the public since it is argued that they should play a part in health care decision making. Finally, the potential value of screening was determined using a decision model based on the results obtained from this study.

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