Objectives: To conduct a systematic review of test performance in population screening for oral cancer and precancer and to investigate sources of clinical heterogeneity among included studies. Methods: An advisory group oversaw the review which was undertaken in accordance with published guidelines. Nine databases were searched using three facets: population, interventions and outcomes. Of 481 papers retrieved, full texts of 47 were scrutinised by two reviewers. Only prospective investigations of population screening involving clinical examination of the oral mucosa, with gold standard verification (examination by an expert of subjects screened positive and at least a proportion of negatives), were selected. Seven papers describing eight studies were finally included (inter-reviewer kappa = 0.83). Using data from 2x2 contingency tables derived from these eight investigations, a random effects meta-analysis was performed. Results: The weighted pooled value of sensitivity (Sn) was 0.848 (95%CI 0.730, 0.919). The corresponding value for specificity (Sp) was 0.965 (95%CI 0.930, 0.982). Main sources of clinical heterogeneity occurred between large house-to-house case finding programmes from SE Asia, utilising primary health workers as screeners, and smaller studies from England and Japan using dentists. Meta-analysis regression showed no evidence of a difference in the generally high level of discriminatory ability of the test between these two groups. Conclusions: Meta-analysis produced a range of values for test performance (Sn, Sp), an important interim measure of population screening effectiveness. The main sources of clincical heterogeneity among included studies were identified. Supported by UK NHS R&D HTA grant 99/46/02

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