{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:58:35Z","timestamp":1791392315395,"version":"4.3.3"},"reference-count":0,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We estimated the clinical and lifetime natural history of oral cancer to inform empirical screening and surveillance algorithms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used data from ever-chewers\/smokers\/alcohol drinkers in the screening arm of the Kerala Oral Cancer Screening Trial (1996-2010), who attended at least one screen (n\u2009=\u200941,225) or two consecutive screens (n\u2009=\u200928,821). The clinical natural history (sensitivity, positive predictive value [PPV] and complement of negative predictive value [cNPV]) was estimated using Kaplan-Meier methods. The multistate natural history across initiation of chewing\/smoking\/drinking, precancer, early-stage cancer, late-stage cancer, and competing mortality was estimated using semi-Markov models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Visual-inspection over 2 consecutive screens (median=3.5 years apart [IQR=2.9-3.9]) had sensitivity=89.2%, PPV=1.55%, and NPV=99.96% for prevalent oral cancers (n\u2009=\u200983). On the first screen, 10.0% were positive with a referable oral lesion\/precancer, and 12.9% were positive on either screen. Screen-positivity on both screens provided 32-fold risk-stratification for incident cancers over 11 years of follow-up (PPV=4.13% vs. cNPV in persistent screen-negatives=0.13%). Screen-positives on either screen accounted for 66.1% of incident oral cancers through 11 years of follow-up. In the lifetime\/multistate model, an estimated mean=18.2% of ever-smokers\/chewers\/drinkers would develop oral precancer and mean=6.04% would progress from precancer to early-stage cancer (mean sojourn=19.3 years). The estimated mean sojourn time from early-stage to late-stage oral cancer was 2.7 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Oral cancer screening intervals could be extended to 10 years for repeat negatives on 2 consecutive screens. The high PPV and short sojourn time from early-stage to late-stage cancer indicate the need for intensive surveillance among screen-positives with precancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinicaltrials.gov identifier<\/jats:title>\n                    <jats:p>NCT04494620.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag360","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:51:58Z","timestamp":1790855518000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical and lifetime natural history of oral cancer: implications for screening and surveillance"],"prefix":"10.1093","author":[{"given":"Li C","family":"Cheung","sequence":"first","affiliation":[{"name":"National Institutes of Health Division of Cancer Epidemiology and Genetics, National Cancer Institute, , Rockville, MD,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guannan","family":"Chen","sequence":"additional","affiliation":[{"name":"George Washington University , Washington DC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Muwonge","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer , Lyon,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Reeve","sequence":"additional","affiliation":[{"name":"National Institutes of Health Division of Cancer Epidemiology and Genetics, National Cancer Institute, , Rockville, MD,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gigi","family":"Thomas","sequence":"additional","affiliation":[{"name":"Regional Cancer Center , Trivandrum,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thara","family":"Somanathan","sequence":"additional","affiliation":[{"name":"Regional Cancer Center , Trivandrum,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangya","family":"Mao","sequence":"additional","affiliation":[{"name":"National Institutes of Health Division of Cancer Epidemiology and Genetics, National Cancer Institute, , Rockville, MD,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Pan","sequence":"additional","affiliation":[{"name":"George Washington University , Washington DC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Partha","family":"Basu","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer , Lyon,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rengaswamy","family":"Sankaranarayanan","sequence":"additional","affiliation":[{"name":"Karkinos Healthcare , Mumbai,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunnambath","family":"Ramadas","sequence":"additional","affiliation":[{"name":"Karkinos Healthcare , Mumbai,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil K","family":"Chaturvedi","sequence":"additional","affiliation":[{"name":"National Institutes of Health Division of Cancer Epidemiology and Genetics, National Cancer Institute, , Rockville, MD,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,7]]},"container-title":["JNCI: Journal of the National Cancer Institute"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djag360\/71666873\/djag360.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djag360\/71666873\/djag360.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:35:53Z","timestamp":1791390953000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article\/doi\/10.1093\/jnci\/djag360\/8875888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/jnci\/djag360","relation":{},"ISSN":["0027-8874","1460-2105"],"issn-type":[{"value":"0027-8874","type":"print"},{"value":"1460-2105","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"djag360"}}