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Related Experiment Videos

Fast-track referrals for oral lesions: a prospective study.

H V Shah1, R W Williams, G H Irvine

  • 1Department of Oral and Maxillofacial Surgery, Southmead Hospital, Southmead, Bristol BS10 5NB, UK. henry@ghirv.freeserve.co.uk

The British Journal of Oral & Maxillofacial Surgery
|July 5, 2005
PubMed
Summary

The 14-day rule for fast-track cancer referrals shows low cancer detection rates and high numbers of non-urgent referrals. Most patients with oral lesions were referred for ulceration, with few malignancies diagnosed.

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Area of Science:

  • Oral surgery
  • Oncology
  • Public health policy

Background:

  • The 14-day rule for cancer referrals was introduced in 1999.
  • Concerns exist regarding low cancer detection rates and high inappropriate referrals within this system.
  • Fast-track referral systems aim to expedite diagnosis for suspected cancers.

Purpose of the Study:

  • To evaluate the diagnostic yield of fast-track referrals for oral lesions.
  • To assess the appropriateness of referrals under the 14-day rule for head and neck cancers.
  • To analyze patient demographics and referral patterns in a fast-track system.

Main Methods:

  • Prospective study of 150 consecutive patients with oral lesions referred to oral and maxillofacial surgery.
  • Utilized a "two week wait" fast-track referral system for head and neck cancers.

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  • Collected data on cancer detection, patient age/sex, referral timeliness, and final diagnoses.

    • Main Results:

    • 80% of patients (120) were referred for oral ulceration.
    • All patients were seen within the 2-week timeframe (mean 6 days).
    • Malignancy was diagnosed in 6% (9 patients); 11% (17 patients) had no abnormality.

    Conclusions:

    • Fast-track referral systems for head and neck cancers have a low yield for diagnosing malignancy.
    • A significant proportion of referrals are non-urgent, suggesting potential overuse of the system.
    • The study supports existing evidence on the low diagnostic yield and high referral rates in fast-track cancer pathways.