Dentist referrals could delay mouth cancer diagnosis warn surgeons

Patients with suspected mouth cancer are having their diagnosis delayed because they are first referred to a dentist, surgeons have warned.

They disagree with the current guidance from the National Institute for Health and Care Excellence (Nice), which says patients with a lump, or a red or white patch in their mouth should be sent for ‘assessment for possible oral cancer by a dentist’ within two weeks of seeing their GP.

They warn that this can slow down the process for diagnosing people with oral cancer and instead patients should see a hospital specialist within two weeks.

Writing in the British Journal of Oral and Maxillofacial Surgery (BJOMS), they estimate that around 11% of patients could have their diagnosis delayed due to the current Nice guidlines.

The experts reviewed 91 referrals and six patients were subsequently diagnosed with cancer. Nine referrals would have gone to a dentist first and out of these one patient was eventually diagnosed with oral cancer.

David Grimes, lead author and British Association of Oral and Maxillofacial Surgeons (BAOMS) fellow in training, said the Nice guidance could expose patients to an increased risk of delayed referral because there is no clear referral pathway between doctors and dentists for suspected cases of oral cancer.

As a consequence patients may suffer delays in having their cancer diagnosed, when in fact they are more likely to be cured if diagnosed at an early stage

Mike Bater, from the BAOMS, said the organisation had raised concerns with Nice regarding the changes in referrals several months ago, after an earlier audit found that half of the mouth cancer cases were diagnosed at an advanced stage.

Professor Richard Shaw, a surgeon specialising in head & neck and oral cancers at the University of Liverpool has, over the last 15 years, seen at first-hand the effects of late diagnosis of oral cancers.

“Stage I and II disease can have excellent outcomes, with around eight or nine out of ten patients surviving for five years or more, often after relatively simple treatment.

“But patients with more advanced stages (III and IV) often need complex treatment – radiotherapy, even chemotherapy – and even so, just three or four out of ten survive for five years.

“Unfortunately around half of the patients I see fall into this latter category.”

It has become clear that dentists, as well as GPs, have a role to play in spotting these signs, as they tend to have a higher level of experience and expertise in oral examination. However, only 50% of the UK population is registered with a dentist or regularly goes for check-ups.

Oral cancer rates are higher among people who don’t have easy access to a dentist – particularly people from lower-income groups, he adds.

It is estimated that more than 7,500 cases of mouth cancer are diagnosed in the UK each year and more than 2,300 people die from the disease.

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