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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
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.
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.
- 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.