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. 2010 Jul 27;103(3):303-9.
doi: 10.1038/sj.bjc.6605778. Epub 2010 Jul 13.

Derivation and validation of a risk-factor model for detection of oral potentially malignant disorders in populations with high prevalence

H K Amarasinghe  1 , N W Johnson, R Lalloo, M Kumaraarachchi, S Warnakulasuriya
Affiliations

Derivation and validation of a risk-factor model for detection of oral potentially malignant disorders in populations with high prevalence

H K Amarasinghe et al. Br J Cancer. .

Abstract

Background: Oral and pharyngeal cancers constitute the sixth most common type of cancer globally, with high morbidity and mortality. In many countries, most cases of oral cancer arise from long-standing, pre-existing lesions, yet advanced malignancies prevail. A new approach to early detection is needed. We aimed to validate a model for screening so that only high-risk individuals receive the clinical examination.

Methods: A community-based case-control study (n=1029) in rural Sri Lanka assessed risk factors and markers for oral potentially malignant disorders (OPMD) by administering a questionnaire followed by an oral examination. We then developed a model based on age, socioeconomic status and habits of betel-quid chewing, alcohol drinking and tobacco smoking, with weightings based on odds ratios from the multiple logistic regression. A total, single score was calculated per individual. Standard receiver-operator characteristic curves were plotted for the total score and presence of OPMD. The model was validated on a new sample of 410 subjects in a different community.

Results: A score of 12.0 produced optimal sensitivity (95.5%), specificity (75.9%), false-positive rate (24.0%), false-negative rate (4.5%), positive predictive value (35.9%) and negative predictive value (99.2%).

Conclusion: This model is suitable for detection of OPMD and oral cancer in high-risk communities, for example, in Asia, the Pacific and the global diaspora therefrom. A combined risk-factor score of 12.0 was optimal for participation in oral cancer/OPMD screening in Sri Lanka. The model, or local adaptations, should have wide applicability.

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Figures

Figure 1
Figure 1
(A) The ROC curve for risk-factor model score and the presence of OPMD (except lichen planus) in Phase 1 study. (B) The ROC curve for risk-factor model score and the presence of all oral mucosal disorders in Phase 1 study.
Figure 2
Figure 2
(A) The ROC curve for risk-factor model score and the presence of OPMD (except lichen planus) in Phase 2 validation study. (B) The ROC curve for risk-factor model score and the presence of all oral mucosal disorders in Phase 2 validation study.
See this image and copyright information in PMC

References

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