Oral facial surgeons say data shows new NICE guidance delays mouth cancer diagnosis
Cases rocket by 39% in last decade alone
23 November 2016 (Last updated: 23 Nov 2016 16:12)
Oral facial surgeons say data shows new NICE guidance delays mouth cancer diagnosis as cases rocket by 39% in last decade alone
Oral facial surgeons say new NICE guidance for oral cancer is causing delays in diagnosis and treatment. 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% in the last decade, and by 92% 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% 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 Dr 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% to 90%.”
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, the lack of access to primary dental care, and 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.”
For further information and interviews contact: Siân Evans on 020 8674 8921 / 07752 414433 or BAOMS on 020 7405 8074
Notes to editors
The British Association of Oral and Maxillofacial Surgeons (BAOMS) promotes the advancement of education, research and the development of oral and maxillofacial Surgery in Great Britain, and encourages and assists postgraduate education, study and research. About BAOMS
NICE guidance NG12 Suspected cancer: recognition and referral
Oral Health Foundation Mouth Cancer Action Month
Read the BJOMS article New NICE referral guidance for oral cancer: does it risk delay in diagnosis?
* Some patients in this context refers to patients that meet certain criteria will be referred to a dentist, but those that do not are referred directly to hospital via the two-week wait pathway. The NICE guidance NG12 does not explicitly define the pathway or have quality control measures.
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