The role of general practitioner in the detection of epithelial hyperplastic lesions and carcinoma of the larynx.
The present study deals with the approach of 78 general practitioners (GPs) in south-eastern Slovenia (mainly in Dolenjska region with population of 234,000) to patients with symptoms of laryngeal disease in the period 1990-95. Only 2 of the GPs (2.6%) examined the larynx of such patients with a laryngeal mirror, while the remainder failed to perform a larynx examination. None of the GPs had a rigid 90 degrees telescope. General practitioners usually treated their patients with laryngeal complaints by antibiotic therapy, and in some cases also by inhalations. Patients with persistent laryngeal symptoms were referred to an otorhinolaryngologist. We have also established who (the patient, GP, otorhinolaryngologist) and to what extent was responsible for the delay at diagnosis of laryngeal cancer, and determined how many months had lapsed from initial symptoms to the first check-up with a GP. Our analysis has shown that in 23 patients (20%) laryngeal cancer was detected in an advanced stage due to a prolonged and incorrect treatment administered by a GP. Patients with cancer of the glottis delayed their visit to their GP for 2 months on average, while in those with cancer of the supraglottis and subglottis this delay was 6 months. In carcinoma of the glottis, the average delay from the onset of first symptoms to diagnosis was 3 months, while in the case of carcinoma of the supraglottis and subglottis this delay was even longer than 7 months. The patients with carcinoma of the supraglottis and subglottis were given 2 months of antibiotic treatment by a GP without having the diagnosis established. We believe that the GP could contribute significantly towards earlier diagnosis of hyperplastic changes of the laryngeal mucosa, which can lead to cancer transformation, as well as to laryngeal cancer detection at an early stage. This could be achieved in the following ways: GPs should examine the patients' larynx by indirect laryngoscopy. In the case where they are not adequately qualified or equipped to perform the examination, they should refer them to an otorhinolaryngologist in due time. A much greater proportion of patients with symptoms of laryngeal disease would have appeared for the examination sooner, had the general population been offered regular and sufficient health education by GPs.
Mlacak
B
B
Health Centre, Metlika, Slovenia.
Fischinger
J
J
D004848:Epithelium / Q000473:pathology; D005194:Family Practice; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007818:Laryngeal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D007820:Laryngeal Mucosa / Q000473:pathology; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D007828:Laryngoscopy; D008297:Male; D010818:Practice Patterns, Physicians'; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology; D012017:Referral and Consultation; D017524:Slovenia / Q000453:epidemiology