Accuracy of the Head and Neck Cancer Risk Calculator in oral and maxillofacial surgery

National waiting time targets demand that patients referred to oral and maxillofacial surgery (OMFS) via an urgent suspicion of cancer (USOC) referral are appointed and investigated quickly, which puts strain on secondary care resources. Despite National Institute for Health and Care Excellence (NICE) referral guidance, many USOC referrals are received for low-risk patients with benign disease, while some patients with head and neck cancer (HNC) are referred via potentially slower pathways. The Head and Neck Cancer Risk Calculator version 2 (HaNC-RC-v2) may be used by primary care referrers to inform referral priority. This tool has been validated mainly in ear, nose, and throat (ENT) settings, with limited evidence for its use in OMFS. This study retrospectively applied the HaNC-RC-v2 and the NICE USOC referral criteria to 476 OMFS patients, using information from electronic medical records and referral letters, to determine the referral priority each tool would have recommended. The sample comprised 200 USOC and 276 non-USOC referrals. HNC was diagnosed in 28 patients (5.9%). The referral priority selected by the primary care clinician accurately reflected the patient's eventual diagnosis in 62.2% of cases. In comparison, the NICE criteria and the HaNC-RC-v2 achieved significantly higher accuracies of 75.5% and 81.9%, respectively (p < 0.05). Both tools also showed significantly greater specificity compared with the clinical judgement of the initial referrer (p < 0.05). If the HaNC-RC-v2 is used by referrers, a significant reduction in USOC referrals of around 50% would be expected (p < 0.0001), with no significant change in cancer detection rates.