The use of tolonium chloride testing in conjunction with oral
physical examination should increase the recorded prevalence of oral
cancer in case-finding (average sensitivity 96.7% with 90.8 average
specificity), however Rosenberg et al demonstrate that the
prevalence remains sufficiently low to limit its usefulness. Several other
issues such as reliability of the screening test, compliance with
screening (affected by the misconception that asymptomatic lesions
are innocuous), follow-up, definitive therapy and cost effectiveness
should be considered for large-scale programs. No cost effectiveness
study has been undertaken to determine whether the reduction in
morbidity or lives saved through treatment of oral cancers at an early
stage is sufficient to offset the cost of an oral cancer screening
program.