title: Utility of oral cancer diagnostic adjuncts in the adult US populations.
abstract: BACKGROUND
  Utility of diagnostic adjuncts (DAs) in an adult population with a low oral and pharyngeal cancer (OPC) prevalence is unclear. In this study, we compare the effectiveness of DAs and clinicians' conventional oral examination (COE) in detecting oral and pharyngeal cancers (OPC), in high-risk (HR) users, low-risk (LR) and alcohol, and in the overall adult US populations (GP).
  
  
  METHODS
  We assumed oral cancer DAs to have 99% sensitivity and specificity. For COE, 79.6% sensitivity and 97.7% specificity were used. Using Altman's mathematical model, the positive predictive values (PPV) for a DA and COE were estimated for HR, LR, and GP groups, respectively. Three different scenarios (sensitivity constant but decreasing specificity, specificity constant but decreasing sensitivity, and decreasing both sensitivity and specificity simultaneously) were developed to simulate the true effectiveness of DAs while keeping the prevalence of OPC in HR, LR, and GP groups constant at 0.4039%, 0.0362%, and 0.1109%, respectively.
  
  
  RESULTS
  The PPVs for a DA in HR, LR, and GP groups in the United States were estimated at 29%, 3%, and 10%, while for COE, the PPVs would be at 12%, 1%, and 4%, respectively.
  
  
  CONCLUSIONS
  Utility of DAs in LR and GP groups is negligible due to very low OPC prevalence in these populations. In HR population, DAs may have a slightly better effectiveness than clinicians only when assumed to have high sensitivity and specificity.
authors.affiliation: Department of Cariology and Restorative Sciences, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, FL 33328, USA. vinodh.bhoopathi@nova.edu
authors.forename: Vinodh
authors.initials: V
authors.lastname: Bhoopathi
authors.forename: Ana Karina
authors.initials: AK
authors.lastname: Mascarenhas
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D003581:Cytodiagnosis / Q000295:instrumentation; D005188:False Negative Reactions; D005189:False Positive Reactions; D005453:Fluorescence; D006801:Humans; D008027:Light; D008403:Mass Screening / Q000706:statistics & numerical data*; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D010610:Pharyngeal Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D010808:Physical Examination; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology