Effectiveness and Utility of Oral Cancer Diagnostic Adjuncts in Adult US Populations

Objective. To compare the effectiveness of oral cancer diagnostic adjuncts (DA) and clinicians’ conventional oral examination (COE) in detecting oral and pharyngeal cancers (OPC), in high-risk (HR), low-risk (LR), and in the overall adult US populations (GP). Background. Though it is important that new oral cancer diagnostics are made available for public’s use, it is even more imperative to question if they are effective in truly detecting oral cancer. Methods. We assumed DAs to have 99% sensitivity and 9 specificity. For COE, 79.6% sensitivity, and 97.7% specificity was used. The positive predictive value (PPV) for a DA and COE were estimated for HR, LR and GP groups, respectively. Three different sensitivity analyses (Sensitivity constant but decreasing specificity, specificity constant but decreasing sensitivity, decreasing both sensitivity and specificity simultaneously) were performed to determine the 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 US, 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. In HR population, DAs may have a slightly better effectiveness than clinicians when assumed to have high sensitivity and specificity