title: Early diagnosis in primary oral cancer: is it possible?
abstract: In this treatise oral carcinogenesis is briefly discussed, particularly with regard to the number of cell divisions that is required before cancer reaches a measurable size. At that stage, metastatic spread may have already taken place. Therefore, the term "early diagnosis" is somewhat misleading. The delay in diagnosis of oral cancer is caused both by patients' delay and doctors' delay. The total delay, including scheduling delay, work-up delay and treatment planning delay, varies in different studies, but averages some six months. The total delay is more or less evenly distributed between patients' and doctors' delay and is partly due to the unawareness of oral cancer among the public and professionals, and partly to barriers in the health care system that may prevent patients from seeking dental and medical care. Due to the relatively low incidence of oral cancer it will be difficult to increase the awareness of this cancer type among the public, thereby reducing patients' delay. However, it should be possible to considerably reduce doctors' delay by increasing the awareness of oral cancer among professionals and by improving their diagnostic ability. Population-based annual or semi-annual screening for oral cancer is not cost-effective, high-risk groups such as heavy smokers and drinkers perhaps excluded. Dentists and physicians, and also oral hygienists and nurse practitioners, may play a valuable role in such screening programs.
authors: Department of Oral and Maxillofacial Surgery/Oral Pathology, VUmc/ACTA, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. I.Vanderwaal@vumc.nl
authors: Isaäc
authors: I
authors: van der Waal
authors: Remco
authors: R
authors: de Bree
authors: Ruud
authors: R
authors: Brakenhoff
authors: Jan-Willem
authors: JW
authors: Coebergh
mesh_terms: D015982:Bias; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D006801:Humans; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy