Basic issues in screening for oral cancer among male subpopulation.

The value of population screening for oral cancer among male adults as a method of oral cancer control is an issue of great controversy. Screening programs have different objectives, varying costs, undocumented benefits, and some may have harmful effects. Consequently, these programs are not unanimously accepted and with the many constraints in evaluating these programs, the future of screening as oral cancer prevention strategy is questionable. Basic issues in the prevalence of oral cancer include factors affecting the patient such as age, sex, exposure to carcinogens, plus the site or the type of the neoplasm. Oral cancer afflicts primarily middle-aged and older adults, particularly heavy users of tobacco and alcohol; long-term exposure to ultraviolet radiation may also be important in the initiation of the disease. Eighty percent of oral cancer patients are over 45 years of age. Exposure to tobacco and/or alcohol seems to be a critical factor in the transformation of normal cells to cancer-producing cells. In the U.S.A., 70-80 percent of oral cancers detected occurred in men. 27,000 new cases of oral cancer are found annually in the United States and at least 9,000 of the cases will result in death. Squamous cell carcinomas represent 90 percent of all oral soft tissue cancers. The most common sites are the floor of the mouth, and soft palate complex. Cancers of the lip and tongue show the greatest association with age while major salivary gland cancers show the least. An inexpensive test should be developed in the near future and subjects should be followed carefully.