Home / Training / Manuals / A digital manual for the early diagnosis of oral neoplasia / Foreword


Oral cancer is an important public health problem worldwide, though more particularly in the developing countries of south and south-east Asia. India contributes one third of the global burden of oral cancer, where it is an important cause of death from cancer among both men and women.

The oral cavity is the hollow part of the mouth, which can be very easily accessed for examination. A thorough physical examination of the oral cavity, as an integral component of any physical examination, provides valuable insight into a person’s overall state of health, though unfortunately it often receives minimal attention in routine practice. Of great importance is that cancers, and even pre-malignant lesions, in the mouth can be seen and identified by experienced examiners.

Oral cancer screening by visual inspection is of proven efficacy in preventing deaths from mouth cancer, particularly among those high-risk persons who use tobacco (in any form) or alcohol or both. The aim of this digital atlas is to improve the technical standards of the practice of oral visual inspection and to improve the quality of screening and diagnosis of oral lesions, particularly in countries with limited resources.

This atlas is one of a series of publications from the Screening Group of the International Agency for Research on Cancer (IARC) in the domain of early detection and prevention of oral cancer. It is intended for use by nurses and health workers in the primary health care network, dentists, oncologists and other doctors. It is a useful tool for training nursing, medical and dental students and primary health workers. It can be used as an initial teaching tool, for progressive self-training and evaluation, as well as for quality assurance.

This digital manual contains more than 400 images, which come mainly from on-going and completed IARC oral cancer screening studies in collaboration with the Regional Cancer Centre, Trivandrum, Kerala, Southern India. These studies were supported by the Association for International Cancer Research (AICR) St Andrews, Scotland; Cancer Research UK (CRUK), UK; and the International Agency for Research on Cancer (IARC), and have been carried out in collaboration with local health services. This digital atlas, carefully compiled by the editors, has been reviewed in depth by experts in the field.

This publication is not intended to be either exhaustive or encyclopaedic. It focusses on facilitating early diagnosis of oral premalignant and early malignant lesions by familiarizing health care providers on the commonly encountered oral lesions and their differential clinical diagnosis. Attention is drawn to pitfalls in clinical diagnosis and interpretation. Though they should not be considered as indispensable for day-to-day diagnosis, the CD-ROM does underline the importance of the quality of screening techniques for optimal interpretation.

We are heading for a major increase in the burden of cancer in low- and medium-income countries in the coming years, and every step must be taken to reduce the impact. Reducing tobacco use and alcohol consumption will lead to a reduction in the incidence of oral cancer, and we know that screening, using visual inspection in the hands of highly trained and experienced health professionals, will lead to a reduction in mortality from oral cancer through early detection of the lesion.

We are sure that this digital learning resource will contribute to improving coverage and standards of oral cancer screening and clinical early diagnosis, especially in lower resource countries, and will contribute to further improvements in health, particularly in the prevention, early detection and successful treatment of oral cancer.

Peter Boyle, Ph.D.
International Agency for Research on Cancer

Balakrishnan Rajan, MD
Regional Cancer Centre
25 avenue Tony Garnier CS 90627 69366, LYON CEDEX 07 France - Tel: +33 (0)4 72 73 84 85
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