This paper presents a promising screening tool for oral cancer – using a simple chlorhexidine mouth-rinse. The hypermethylated ZNF582 and PAX1 markers were chosen based on previous studies using oral scraping methods of collection and have been shown to be particularly useful in patients with tobacco and alcohol risk-factors. Patients included both those attending for routine screening (offered biannually in Taiwan) and those found to have a suspicious lesion in primary care. Of the 267 patients included in the study, 60 were normal, 111 had potentially malignant lesions, and 96 had possible oral cancer, based on visual oral examination. The study found that the mouth-rinse method had positive results which increased as lesions became more malignant, with acceptable sensitivity, specificity, area under the curve and odds ratio. In particular, the methylation levels jumped significantly from mild dysplasia to moderate / severe dysplasia. The authors propose that this method also has a role in post-treatment surveillance, particularly in patients with limited mouth opening. The ‘normal’ patients did not undergo oral biopsy, which is a limitation of this study, offset by as-yet unpublished three-year follow-up of these patients. The progress in the ability of biomarkers to detect oral dysplasia and squamous cell carcinoma has led to the development of a simple to use, non-invasive test which aims to assist early diagnosis in the general population.

Hypermethylated ZNF582 and PAX1 genes in mouth rinse samples as biomarkers for oral dysplasia and oral cancer detection.
Cheng S-J, Chang C-F, Ko H-H, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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