title: Delay in diagnosis and referral patterns of 646 patients with oral and maxillofacial cancer: a report from a single institution in Hamburg, Germany.
abstract: Improvement in therapy for malignant diseases in the oral and maxillofacial (OMF) region rests mainly upon diagnosis at an early stage of the disease. This study performed an analysis of the delays between symptom onset and time taken for patients to seek medical advice and then their subsequent specialist referral to the Department of OMF Surgery at Eppendorf University Hospital.
  
  
  METHODS
  The files of 646 patients (males: 451, females: 195) with malignancies of the OMF region who were treated during an interval of 19 years were analysed retrospectively.
  
  
  RESULTS
  Localized swelling, pain and alterations of the mucosa were the predominant first signs and symptoms of disease. Stage grouping according to the TNM system (UICC, 1992) revealed advanced stages in the majority of cases (IV: 30%, III: 15%). The majority of patients were referred by residents in OMF surgery (31.7%) and dentists (28.8%) and were hospitalized within 4 months after notification of the first symptoms (66.9%).
  
  
  CONCLUSIONS
  Both outreach work of public health institutions and continuous education during studies in both medicine and dentistry, and in further education play a key role in reducing diagnostic delay in OMF cancer.
authors.affiliation: Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany. r.friedrich@uke.uni-hamburg.de
authors.forename: Reinhard E
authors.initials: RE
authors.lastname: Friedrich
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D009367:Neoplasm Staging; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013515:Surgery, Oral / Q000379:methods*; D013997:Time Factors