Writing up their findings in the British Journal of Oral and Maxillofacial Surgery (BJOMS), they say that the new referral guidance does not have a defined referral pathway between doctors and dentists for some patients* with suspected cancer.
Mouth cancer cases in the UK have rocketed by 39 per cent in the last decade, and by 92 per cent since the 1970s. Lead author and British Association of Oral and Maxillofacial Surgeons (BAOMS) Fellow in training, David Grimes, argues that new NICE guidance (NG12) “may expose patients to increased risk of delayed referral because there is no clear referral pathway between doctors and dentists for suspected cancer”. As a consequence he says for some people the NICE guidance may result in delayed cancer diagnosis.
Co-author, Jaymit Patel, explains: “When we saw the most recent guidelines we were concerned about the recommendation for GPs to refer some patients* directly to dentists when no agreed pathway exists. We considered that this could lead to a delay in the review of the patient’s case by an appropriately trained professional, so we decided to audit our caseload to see what the effect might be.”
David Grimes already had concerns about delays from an earlier audit he carried out where he found that half of the mouth cancer cases were diagnosed at an advanced stage. His fears were further reinforced by the report of 25 per cent of oral cancers diagnosed at an advanced stage in the DAHNO Tenth Annual Report National Head and Neck Cancer Audit published in 2015: “This is why we all felt that a clear referral pathway is essential to ensure patients are diagnosed as early as possible.”
Mike Bater, BAOMS Deputy oncology sub specialty interest group (SSIG) lead, said that BAOMS had raised concerns with NICE regarding the changes in the referral pathway for patients with suspected oral cancer some months ago.
“This paper demonstrates that changes in the pathway introduce an avoidable delay in patient referral, potentially leading to a compromise in treatment success. We know that patients with mouth cancer are more likely to be cured if the disease is diagnosed at an early stage, and also that the morbidity (side effects) from treatment increase if the diagnosis is made late.”
The analysis of findings is published just as the Oral Health Foundation has embarked on the month long mouth cancer awareness campaign throughout November 2016.
The Oral Health Foundation CEO Nigel Carter says that, despite best efforts, survival rates for mouth cancers have not improved in the last 20 years. As a result he is urging everybody to be more mouthaware whether they are clinicians or patients: “Early diagnosis transforms a person’s chances of beating the disease from 50 per cent to 90 per cent.”
Christopher Avery, consultant oral and maxillofacial surgeon and researcher for BAOMS, adds that the surgeons are concerned that older men are least likely to use primary dental care services and are most at risk of developing oral cancer: “Our data combined with the epidemiological evidence and the lack of access to primary dental care and a quality assessed referral pathway between providers of primary care means that the current guidance has the potential for more delays than the one it has replaced.”