title: An appraisal of oral cancer and pre-cancer screening programmes in Europe: a systematic review.
abstract: BACKGROUND
  Close to 50% of oral cancer (OC) patients still present in advanced stages of disease. Screening, in medicine and dentistry, is a strategy to identify an unrecognised disorder in individuals without signs and symptoms. There are several cancers that fit valid criteria for screening, but whether or not to screen a population for OC remains a dilemma. However, many screening programmes for OC and detection of potentially malignant disorders are described. Many of these have been conducted in Europe, but the feasibility of screening for OC has not been systematically addressed.
  
  
  METHODS
  A systematic review was conducted using the key words of interest. Based on our inclusion criteria, 16 European studies spanning three decades were selected from the published English literature. These studies were systematically analysed. The results were discussed with an expert EU consortium built with the task to promote the early detection of OC.
  
  
  RESULTS
  There were no consistent results or conclusions across the studies reviewed, largely as a result of there being a wide variety in the screening models and methods of data analysis adopted by each group. In nine of the studies reviewed, whilst descriptive findings from screening were presented, the authors had not attempted to analyse the outcomes. Additionally, only one study reported follow-up data of the screened population.
  
  
  CONCLUSIONS
  In order to uphold the benefits of screening, it is necessary to demonstrate an improvement in survival rates following early detection. No such randomised control trials (RCT) on OC have been undertaken in Europe. Undertaking such a RCT may be difficult in the European setting. However, the feasibility of screening for OPMDs by conventional oral examination has been demonstrated, supporting a strategy to adopt appropriate screening models, and further action from the European countries should be to demonstrate methods of halting their progression by tested interventions. We provide a brief guideline for future screening studies.
authors.affiliation: King's College London, WHO Collaborating Centre for Oral Cancer, London, UK.
authors.forename: Saman
authors.initials: S
authors.lastname: Warnakulasuriya
authors.affiliation: King's College London, WHO Collaborating Centre for Oral Cancer, London, UK.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fennell
authors.affiliation: University of Santiago de Compostela, Galicia, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Diz
authors.affiliation: University of Santiago de Compostela, Galicia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Seoane
authors.affiliation: Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rapidis
mesh_terms: D055088:Early Detection of Cancer; D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D010808:Physical Examination; D011230:Precancerous Conditions / Q000175:diagnosis*; D015996:Survival Rate
keywords: early detection; early diagnosis; oral cancer; potentially malignant disorders; pre-cancer; screening programmes