16
Jul
2026
16
Jul
2026
Learning objectives
After reading this article, practitioners should be able to:
Introduction
Throughout my career as a clinician and educator, one principle has remained constant: the earlier we identify disease, the greater the opportunity to improve outcomes for our patients.
Testing plays a central role throughout healthcare. Whether we are screening for cervical cancer, monitoring blood glucose levels, assessing cardiovascular risk or evaluating suspicious skin lesions, clinicians increasingly rely on objective information to support decision-making.
Oral cancer should be no different.
Despite advances in healthcare, oral cancer remains a significant global challenge. According to the World Health Organisation, almost 390,000 new cases of lip and oral cavity cancer were diagnosed worldwide in 2022, resulting in more than 188,000 deaths. Survival rates have improved only modestly over recent decades, largely because many patients continue to be diagnosed at an advanced stage, when treatment becomes more complex and outcomes less favourable. Early detection remains one of the most effective ways to improve patient prognosis.
For oral health professionals, this presents an important challenge. Routine appointments provide valuable opportunities to identify abnormalities that may otherwise go unnoticed.
The reality is straightforward. When oral cancer is detected early, outcomes improve dramatically. When detection is delayed, treatment becomes more invasive, more complex and often more life-changing for the patient.
The question, therefore, becomes: are we doing enough to identify risk as early as possible?
The challenge of early detection
One of the greatest difficulties in oral cancer detection is that early-stage disease often presents with subtle or non-specific signs.
Patients may be completely asymptomatic. Others may present with lesions that appear clinically unremarkable. Some abnormalities can remain stable for long periods before undergoing malignant transformation.
In my experience:
“The challenge is not identifying the obvious cancer. The challenge is identifying the patient who may be on the pathway towards cancer before that transformation becomes clinically apparent.”
This is particularly relevant when considering Oral Potentially Malignant Disorders (OPMDs).
Current evidence suggests that OPMDs are associated with a significant proportion of oral cancers and that the overall malignant transformation rate is approximately 7.9%. Common examples include leukoplakia, erythroplakia, oral lichen planus and oral submucous fibrosis.
For busy clinicians, this creates a challenge. Most lesions will never become malignant, but identifying the small number that may progress remains difficult using appearance alone.
The limitations of ‘watch and wait’
Visual Oral Examination (VOE) remains the cornerstone of oral cancer screening and will continue to play a vital role in clinical practice.
However, visual assessment is inherently subjective and heavily dependent on practitioner experience. Research suggests that conventional visual examination alone may achieve sensitivities of approximately 60-70%, meaning some potentially serious lesions may be missed or underestimated.
For many clinicians, this creates a familiar dilemma. The lesion may not appear overtly sinister, but equally it may not look entirely normal. Deciding whether to review, refer or investigate further can be challenging, particularly when patients are asymptomatic.
Historically, uncertainty has often resulted in a cautious ‘watch and wait’ approach.
While understandable, this approach carries risk.
More than 70% of oral cancers continue to be diagnosed at Stage III or Stage IV disease, when treatment becomes substantially more invasive and prognosis worsens.
As clinicians, we should remember:
“Watching is not treating. Every delay represents a lost opportunity to identify disease at a stage when intervention may be simpler, less invasive and potentially lifesaving.”
Why earlier detection changes everything
The difference between early and late diagnosis is profound.
Patients diagnosed with Stage I or Stage II disease may achieve survival rates approaching 80-90%. By contrast, overall five-year survival rates remain close to 50% when cancers are detected later.
Earlier intervention is often associated with:
In other words, early detection does not simply improve survival statistics. It can fundamentally change the patient’s entire treatment journey.
“Most clinicians would not dream of making important healthcare decisions without objective information. Oral cancer detection should be no different. The earlier we can identify elevated risk, the greater the opportunity to improve patient outcomes.”
The emergence of biomarker-based testing
Across healthcare, biomarkers are increasingly being used to support earlier diagnosis and risk stratification.
As oral tissues undergo malignant transformation, measurable biological changes can occur before advanced clinical symptoms develop. Identifying these changes may provide additional information beyond visual assessment alone.
One example of this emerging category of technology is the BeVigilant OraFusion System, a chairside saliva-based assessment tool designed to support oral cancer risk evaluation. Rather than replacing clinical judgement, it is intended to complement the standard visual oral examination.
The system combines:
Two biomarkers associated with oral cancer development - p16 and EGFR - are measured using a lateral flow immunoassay. These results are then combined with recognised clinical risk factors to generate an objective risk assessment.
The process is non-invasive, chairside and delivers results in approximately 15 minutes.
Can testing improve clinical decision-making?
Perhaps the most important question is whether testing changes practitioner behaviour.
A study evaluating the use of OraFusion examined how clinicians assessed oral abnormalities before and after receiving biomarker-supported risk information.
Using visual examination alone, participating clinicians achieved an average sensitivity of 70% and specificity of 63%.
When OraFusion risk assessment data were incorporated, sensitivity increased to 100% and specificity to 99% within the study model. Investigators reported that clinicians identified substantially more malignant lesions and altered referral decisions accordingly.
While further real-world evidence will continue to emerge, the findings highlight an important principle: additional information can support more informed clinical decision making.
Limitations and clinical considerations
It is important to recognise that no diagnostic test should be viewed in isolation.
Biomarker-based assessments are designed to support clinical decision-making, not replace it. Patient history, risk factors, clinical examination and appropriate referral pathways remain essential components of care.
Like all screening and risk assessment tools, biomarker testing has limitations. Results must be interpreted within the wider clinical context, and practitioners should continue to exercise professional judgement when determining the most appropriate course of action.
The value of testing lies in providing additional objective information that may help reduce uncertainty when assessing potentially malignant lesions and determining appropriate next steps.
Why this matters to aesthetic practitioners
Many aesthetic practitioners routinely examine areas of the face, lips and perioral region during consultation and treatment planning. In some cases, they may see patients more frequently than their dentist.
As a result, aesthetic clinicians can play an important role in recognising changes that may warrant further investigation.
While aesthetic practitioners are not responsible for diagnosing oral cancer, maintaining awareness of potential warning signs and ensuring appropriate referral can contribute to earlier identification and better patient outcomes.
As healthcare increasingly embraces preventive and collaborative approaches, recognising risk and signposting patients appropriately is becoming an important part of delivering comprehensive patient care.
Conclusion
In many areas of healthcare, objective testing is now considered an essential part of identifying disease at an earlier and more treatable stage.
Oral cancer presents a compelling case for applying the same philosophy.
Visual examination remains fundamental, but clinicians are increasingly recognising the value of additional information when assessing potentially malignant lesions and determining appropriate referral pathways.
Technologies such as biomarker-based risk assessment are not intended to replace clinical expertise. They are intended to support it.
Having spent many years involved in oral health, facial aesthetics and clinician education, I remain convinced that earlier detection represents one of the greatest opportunities we have to improve outcomes for patients at risk of oral cancer.
For practitioners committed to improving patient outcomes, the question may no longer be whether testing has a role to play, but how it can be incorporated effectively into everyday clinical practice.
Because when it comes to oral cancer, timing matters. The earlier we identify risk, the greater the opportunity to change lives.
Further learning
Professor Bob Khanna Webinar: Early Detection of Oral Cancer and the Role of Biomarker-Based Assessment
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