Look in the mouth, skip the saliva test: oral cancer detection still starts with an examination

The edition in brief

A living, GRADE-based guideline on early detection of oral squamous cell carcinoma concluded that commercially available salivary adjunct tests should be used only in research, whether to screen people without lesions or to decide whether a visible lesion needs biopsy. Its good practice statements: examine every adult's mouth, and biopsy or refer any persistent mucosal abnormality. In an inner-London borough, 158 645 eligible adults were followed from 2009 to 2023; attending at least one NHS Health Check was associated with lower all-cause mortality (adjusted HR 0.68), with the largest absolute difference at ages 70–74, though residual confounding remains possible. A Singapore polyclinic programme that reorganised doctors into small teams of two family physicians, a nurse and a care coordinator produced only modest changes in HbA1c, blood pressure and LDL over five years, but 16% more foot screens, 6% more eye screens, fewer admissions and net savings of about SGD 2186 per patient. A meta-analysis of seven Indian studies estimated sarcopenia in about one in four adults with type 2 diabetes, with very low certainty and a prediction interval from 7% to 66%. The pearl lists the oral lesions that need referral rather than review.