Fast-track referrals for oral lesions: a prospective study

Since the introduction of the 14-day rule for referrals for cancer in 1999 there has been some suspicion that rates of detection of cancer are low and the number of inappropriate referrals is high. We undertook a prospective study of 150 consecutive patients with oral lesions referred to a department of oral and maxillofacial surgery in a teaching hospital that uses a "two week wait" fast-track referral system for head and neck cancers. The main outcome measures were the number of cancers detected, the age and sex of the patients, the number seen within 2 weeks, by whom, and the final diagnosis. Most patients (n=120, 80%) were referred with oral ulceration. All patients were seen within 2 weeks (mean 6 days). Nine patients (6%) had a diagnosis of malignancy and 17 (11%) had no detectable abnormality. The study confirms what others have shown, that the yield of diagnoses of malignant disease from fast-track referrals is low and the number of non-urgent referrals is high.