Factors Associated with Delay in the Diagnosis of Oral Cancer

Abstract

Early detection and treatment improve the prognosis for oral cancer. Delays from the onset of symptoms to clinical diagnosis are common. Our aim is to identify factors associated with this delay. Between 1995 and 1998, we interviewed 105 consecutive patients with histologically confirmed oral cancer in Greece. If 21 or more days elapsed from the time the patient noticed major symptoms to a definitive diagnosis, we called it a delay (52% of cases). We used logistic and linear regression to estimate odds ratios of delayed diagnosis and to identify correlates of length of delay, respectively. Former smokers had a 4.3 times greater risk of delayed diagnosis compared with current smokers (95% confidence interval: 1.1-17.1). The length of delay was greater among single patients, non-smokers, or those with stage IV tumors. Clinicians should be advised that delay in the diagnosis of oral cancer occurs frequently, even in individuals who do not smoke heavily.

A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer

“…A set of opening questions was developed for the semi-structured interviews from existing research on delays in oral cancer presentation 7,[15][16][17][18][19][20][21] and the results of an earlier pilot study by the same authors. 22 In accordance with Carter and Henderson, 23 these were open-ended questions and investigated the following areas: experience of soft tissue lesion referrals; factors used in formulating the decision to refer; attitudes to secondary care; and attitudes to other health professionals.…”

Oral Cancer Knowledge, Attitudes, and Practices among Dentists in Khartoum State, Sudan

“…A number of studies have reported referral delays of oral cancer in Australia (Dimitroulis et al, 1992), Brazil (Kowalski et al, 1994), United Kingdom (Hollows et al, 2000), Denmark (Wildt et al, 1995) and Greece (Pitiphat et al, 2002), however the studies are not easily comparable because they were set in different areas and used different methodologies.…”

Oral cancer: Delays in referral and diagnosis persist

“…Similar findings have been reported from Australia, 8 Brazil, 9 Canada, 10 Denmark 11 and Greece. 12 Allison 13 has reviewed the evidence regarding whether delays in the diagnosis of oral cancer once it is clinically detectable actually affects the prognosis of patients, and found that whilst there is  Delays in the diagnosis and referral of oral cancer patients continue to occur despite recent efforts to increase awareness of the disease.  These delays occur at different points in the referral process.…”

“…11,13 Professional delay is defined either as the time from the first consultation with a healthcare professional to the first consultation with a treating specialist, 10,13 or to the definitive diagnosis being made, 8,11,12 or to the patient being admitted for definitive treatment, 9 or as the time from the first consultation until a referral letter is sent to a specialist unit. [4][5][6][7] We would suggest the use of professional delay for the whole time from the patient's first consultation to their commencing definitive treatment.…”