Delay in diagnosis and its effect on outcome in head and neck cancer

We examined the records of two cohorts of patients who were seen from 1960 to 1999 with a diagnosis of squamous cell carcinoma (SCC) of the mouth and throat, one series being retrospective (n=400) and the other prospective (n=213) to find out about delays in diagnosis. The median delay in both cohorts was 3 months and the patients were responsible for the delay in most cases (n=319, 81% and n=160, 78%, respectively). Half the patients in each cohort had delayed diagnoses (n=217, 54% and n=119, 56%, respectively) and similar percentages (n=110, 53% and n=172, 47%) presented with advanced disease (stage III or IV). These were not the same patients for there was no correlation between delay and stage or survival. Logistic regression analysis showed that non-white race (p=0.01) and high-grade histology (p=0.002) predicted advanced disease. The proportion of patients presenting with advanced disease had not changed in 40 years despite public education. We suggest that some tumours may be silent and that initial symptoms do not reliably predict early disease.