Oral cancer: delays in referral and diagnosis persist

Oral cancer accounts for around 1% of all new cancers diagnosed in the United Kingdom every year. Mortality rates remain relatively high and prognosis is worst in cases of more advanced disease at time of diagnosis. Early identification of malignant lesions and speedy referral to a specialist for treatment are therefore important. The reasons and extent of the delays at the different stages between a patient first noticing an oral lesion and attending a health care professional and then being referred for specialist care have previously been studied and consistently found to be longer than desired. The National Oral Cancer Awareness Week (NOCAW), first run in 1995, aimed to increase the awareness of oral cancer amongst health care professionals and the public. It has since been repeated and is now an annual event. Alongside publications by the British Dental Association and guidelines circulated by the Department of Health on oral cancer diagnosis and referral, it is hoped this will lead to a decrease in the delay between the onset of oral cancer and patients receiving appropriate treatment. We looked at the previously published data on referral delay in oral cancer both in the United Kingdom and overseas and then identified delays in referral of oral cancer patients in a region that had been studied before NOCAW was introduced, to see if this was having any effect on referral delays. We found that despite the great publicity raised by NOCAW and the other publications and courses on oral cancer since the original audit, patient delay and referral delay have not improved. We conclude that more needs to be done to transfer guidelines to everyday practice.