title: Role of general practice in the diagnosis of oral cancer.
abstract: The incidence of oral cancer is increasing in the United Kingdom. There is evidence that early diagnosis and effective treatment improve survival, but the poor 5-year survival rate (50%), which has not improved for several decades, has been attributed to advanced stage at presentation. To investigate the symptoms associated with cancer of the oral cavity and to explore the role of general practitioners (GP) in the identification and referral of patients, we sent 200 patients questionnaires on the route to diagnosis, symptoms, delay in presentation, and outcomes of consultations with their GP. Of 161 respondents, over half (56%) had been referred to secondary care by their GP and a third (32%) by their dentist. The most commonly reported symptoms were a mouth ulcer (32%), a lump in the face or neck (28%), and pain or soreness in the mouth or throat (27%). Fifteen per cent delayed presentation for more than 3 months. After consultation with a GP (n=109), 53% were referred to a specialist, 22% were referred for tests, 12% were told that their symptom was not serious, and 12% were treated for another condition. GPs have an important role in the identification and referral of people with oral cancer, and the clearly recognised symptoms identified in this study can be used to aid assessment and decision-making. Interventions to promote the prompt identification of oral cancer in general practice such as the opportunistic screening of high-risk patients may help to improve the poor survival rates.
authors.affiliation: Division of Public Health and Primary Care, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer BN1 9PH, UK. Electronic address: T.Crossman2@bsms.ac.uk.
authors.forename: Timothy
authors.initials: T
authors.lastname: Crossman
authors.affiliation: King's College London Promoting Early Cancer Presentation Group, Capital House, 42 Weston Street, London SE1 3QD, UK. Electronic address: Fiona.Warburton@phe.gov.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Warburton
authors.affiliation: At the time of completing this research: National Cancer Action Team, Portland House, Bressenden Place, London SW1E 5RS, UK. Electronic address: Mike.Richards@cqc.org.uk.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Richards
authors.affiliation: Division of Public Health and Primary Care, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer BN1 9PH, UK. Electronic address: h.e.smith@bsms.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
authors.affiliation: King's College London Promoting Early Cancer Presentation Group, Capital House, 42 Weston Street, London SE1 3QD, UK. Electronic address: amanda-jane.ramirez@kcl.ac.uk.
authors.forename: Amanda
authors.initials: A
authors.lastname: Ramirez
authors.affiliation: King's College London Promoting Early Cancer Presentation Group, Capital House, 42 Weston Street, London SE1 3QD, UK. Electronic address: Lindsay.forbes@kcl.ac.uk.
authors.forename: Lindsay J L
authors.initials: LJ
authors.lastname: Forbes
mesh_terms: D005194:Family Practice; D058005:General Practitioners; D006801:Humans; D009062:Mouth Neoplasms / Q000175:diagnosis*; D012017:Referral and Consultation; D006113:United Kingdom
keywords: Early diagnosis; General practice; Oral cancer; Primary care