Most suspicious patches in the mouth turn out to be harmless. Most patients with one still get cut. A team led by Queen Mary University of London says a brush swab can change that, and that it gives a result within one hour.
The test, called qMIDS-V3, was described in a paper in the journal Biomarker Research. Researchers from several universities worked on it, and the study drew on more than 1,000 samples from 545 patients. Queen Mary says that makes it the largest of its kind. The team reports that the swab could spare over 90% of low-risk patients an unnecessary scalpel biopsy.
The trouble with the scalpel
Doctors call these patches oral potentially malignant disorders. Most are benign, yet the usual response is an invasive biopsy. The university describes the procedure as painful, with a risk of infection. On the gum it is hard to carry out and can damage the tooth or bone beneath. On the tongue, the most common site of oral cancer, the study team puts it bluntly: part of the tongue is cut away. That discourages patients and clinicians from repeating it, so follow-up often comes late.
The numbers on referrals point the same way. A UK audit covering ten years found a 450% rise in two-week-wait referrals, alongside a 50% fall in the cancer detection rate. Later audits found that between 92.5% and 99.5% of those referred had no cancer, and most of them, 96% to 98%, were still cancer free five years on.
Swab versus microbiopsy
The new test grew out of qMIDS-V2, which needs a 1mm tissue sample and was validated on more than 530 samples from the UK, India and China. The brush version removes no tissue at all.
Its performance came out highly comparable to the older version. Professor Muy-Teck Teh, the lead researcher and a specialist in molecular oral oncology at Queen Mary, said the team was “genuinely astonished”. The signal from the four genes the test reads, he explained, is strong enough to be picked up from surface cells alone.
Because a swab can be repeated, patients with persistent lesions could be tested again and again. “We can now monitor patients with persistent pre-malignant lesions regularly and systematically,” Teh said, “and pick up cancers much earlier than we would have been able to before.”
The need is plain. Global Burden of Disease data places lip and oral cancer among the fastest-rising causes of early death. The charity Mouth Cancer says more than ten thousand people in the UK were diagnosed last year and 3,637 died. Worldwide, 650,000 people develop it each year. Tobacco, alcohol, the HPV virus and sun damage are the main risk factors, and 53% of mouth cancers are found at stage IV.
The team also included researchers from King George’s Medical University and Modern Dental College & Research Centre in India, and from the All India Institute of Medical Sciences. Queen Mary is looking for a commercial partner. With the right one, the university says, the test could be in clinical use within two years.
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