Oral Cancer Screening

According to the ACS, a person can perform self-screening by regularly examining their mouth and throat for lumps or white patches. During regular checkups, dentists and hygienists can look for suspicious areas using special tools and may coat them with toluidine blue dye.


PHCWs can transmit images deemed screen positive to a remote specialist. Several studies have shown that screening for new OPMDs is cost-effective, especially when targeted to high-risk groups.


In addition to the usual visual examination, healthcare professionals can use a variety of tools to identify suspicious tissue changes. For instance, they can rinse your mouth with a special fluorescent solution that makes normal tissue glow brightly and abnormal tissue look dark. They can also use a device called a VELscope that shines a light on your tissues to detect changes in the cell structure, such as a potential cancerous lesion.

Many growths in the mouth are not malignant based on their appearance alone. However, some growths are suspicious and warrant further evaluation, such as a biopsy. During a screening, a healthcare professional will brush or scrape the surface of your tongue, lips, cheeks, and throat to collect cells from your mouth for further testing. The cells are then evaluated under a microscope to determine whether or not they are cancerous.

Although some studies have shown a reduction in the incidence of advanced oral squamous cell carcinoma (OSCC) following an organized screening program, others report no benefit (Sankaranarayanan et al. 2002). The inability to identify the impact of screening on early stage disease and survival is partially explained by lead time bias (overdiagnosis).

To overcome these limitations, researchers are investigating different models for organizing and implementing an effective oral cancer screening program. These include house-to-house visits, integrated screening with general health or dental care, and opportunistic screening in medical practices or workplaces.

Early Detection

As with most cancers, early detection is the key to a reduction in death rates. However, the natural history of oral cancers presents unique challenges to screening programs. Aggressive oral squamous cell carcinomas (OSCC) grow quickly, leading to a short potential screening window, and are unlikely to be detected as asymptomatic in a screening population. Conversely, “less aggressive” OSCCs may develop from OPMDs, progress less rapidly, and can be detected asymptomatically during screening. These cases, along with nonprogressing OSCCs that never transform, represent lead time bias and overdiagnosis (Figure 2).

Screening can be as simple as a visual examination of the mouth, or it can include other tests, such as toluidine blue dye. A healthcare provider will rinse your mouth with this special colorant, which makes healthy tissue look dark and abnormal tissue look white so it can be easily seen. The provider will also use his or her fingers to feel for lumps and bumps in the mouth, neck and jaw areas.

Currently, there are no commercially available adjunctive techniques that have been successfully tested in oral cancer screening trials in primary care. Such tests involve “wide-field” evaluations of the oral mucosa beyond what can be visually screened, employ light-based technologies or oral rinses, or require the collection of cells for cytopathology to establish an official diagnosis.


Oral cancer can be cured in its early stages, when it is localized and has not spread to other parts of the body. However, only about 20 percent of people diagnosed with oral cancer receive early treatment. Screening is an important strategy to detect precancerous and cancerous lesions in the mouth. Most of these lesions are visible to the naked eye, and most healthcare professionals can identify them with a thorough visual examination and other methods such as toluidine blue, brush biopsy, or fluorescence staining. These examinations are part of routine dental visits.

Most of the time, oral cancers are detected in late stages, when they have already spread to other parts of the head and neck. As a result, they are difficult to treat and are associated with high death rates. Oral cancers have a long clinical premalignant phase characterized by various precancerous lesions (homogeneous or nonhomogeneous leukoplakia, erythroplakia, oral squamous cell carcinoma of the lip or palate [OSMF] and lichen planus), all of which are readily identifiable with a thorough visual inspection.

Several models for screening for oral cancer have been studied, including targeted and general population-based screening, integrating with general health or opportunistic screening at dental practices, opportunistic screening through schools, work sites, and community events, and telemedicine consultations. A few cost-effectiveness studies have been conducted, but only one of these was set in a LMIC and used decision analytic modeling; the other three were set in HICs and used a randomized trial approach.


Although it is not yet proven that routine oral cancer screening saves lives, it does help to find cancers when they are small and less likely to spread. The most common sites for mouth cancer are the lips, inside of the cheeks, floor of the mouth and tongue. When these cancers are found early, they are much easier to treat.

A comprehensive oral cancer screening requires a visual examination of all areas of the mouth and attached tissues, including the neck, sinuses, larynx and pharynx. A dentist or dental hygienist will check for lumps and sores. They will also feel the tissues with gloved hands to check for any abnormalities.

In addition to the physical examination, an oral cancer screening may include other diagnostic tests. For example, saliva or swab samples may be tested for HPV (human papillomavirus) DNA. A test using a sample of the throat rinse is also available for detection of oncogenic HPV in patients who have oropharynx cancers. A study of this type (using both saliva and throat rinse) showed high sensitivity in identifying HPV-positive oropharynx cancers (Tang et al. 2020).

A biopsy is a procedure that involves collecting tissue for laboratory testing to determine if the cells are normal or malignant. If an abnormal area is found, your healthcare provider will refer you to a specialist for further testing and diagnosis.