title: The two-week wait cancer initiative on oral cancer; the predictive value of urgent referrals to an oral medicine unit.
abstract: BACKGROUND
  The two-week wait cancer initiative was designed to speed up referral of patients suspected of having cancer. The National Institute of Clinical Excellence (NICE) has issued guidelines for head and neck cancers warranting urgent referral.
  
  
  OBJECTIVE
  To look at the appropriate use of the two-week wait/urgent referrals by measuring the proportion of urgent referrals found to have cancer, to assess the sensitivity of the clinical guidelines and to explore how practitioners used them in primary care.
  
  
  METHODS
  Collection and analysis of urgent referral letters and the clinic outcome for urgently referred cases over a one-year period in an oral medicine department. Screening of the biopsy service database to reveal any routine referrals subsequently found to have cancer.
  
  
  RESULTS
  None of the routine referrals but eight percent of all urgent patients were found to have cancer, equating to 24% of the group in which malignancy was suspected. The predictive value of referring a case as suspected of oral cancer/with cancer symptoms was low, estimated at 7.9%.
  
  
  CONCLUSIONS
  The referral guidelines on oral cancer symptoms developed by NICE may need further revision. Moreover, development of other appropriate adjuncts that aid visual inspection for the detection of oral cancer may improve the sensitivity of positive detections in primary care.
authors.affiliation: Department of Oral Medicine and Pathology, WHO Collaborating Centre for Oral Cancer and Precancer, King's College London Dental Institute, Denmark Hill Campus, Caldecot Road, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Singh
authors.forename: S
authors.initials: S
authors.lastname: Warnakulasuriya
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D042241:Early Diagnosis; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors; D006113:United Kingdom; D014850:Waiting Lists