Delay in diagnosis and its effect on outcome in head and neck cancer
Introduction
It is easy to presume that delay in diagnosis results in a larger cancer and a reduction in survival. It is on this premise that the policy was founded to educate the public on the dangers of delay in seeking advice. The success of this policy is anticipated by the fact that the single most important factor that influences the prognosis of head and neck cancer is the stage of the disease at presentation. The 5-year survival for small tumours approaches 80% but falls to 30% for stage IV disease.1, 2, 3 If advanced disease is the result of delay in presentation, then it follows that without such a delay the disease could be treated earlier in its development, with improved survival and reduced morbidity. Our aim was to establish if there is a positive correlation between increased delay in diagnosis and advanced stage at presentation of mouth and throat cancers.
Section snippets
Patients and methods
The data are based on the records of two cohorts of patients with squamous cell carcinoma (SCC) of the mouth or throat who were treated between 1960 and 1999. The first were the records of a series of 930 consecutive patients treated between 1961 and 1986 at a district general hospital. Data on delay in presentation were available in 695, of whom we selected 400. The second was a prospective series of 366 consecutive patients with head and neck cancer treated at a cancer centre from 1992 to
Results
The mean age of the patients was 61 years in the retrospective series (range, 2–99) and 60 years in the prospective series (range, 16–95). The male:female ratio was 1.6:1. The median period of delay in both cohorts was 3 months. The proportion of patients with delay (retrospective series n = 198, 50% and prospective series n = 116, 57%) and advanced disease (retrospective series n = 184, 46% and prospective series n = 112, 54%) was similar and remained essentially unchanged over the 40 years. The
Discussion
It seems obvious that the longer a patient waits from the start of a cancer to diagnosis, the more advanced the cancer will be and the worse the prognosis. But when delay was defined as the period between recognition of symptoms and diagnosis, we found no correlation between delay and either stage of disease at presentation or survival. This is unlikely to be a chance observation as it has been reported in nine other studies.6, 7, 8, 9, 10, 11, 12, 13, 14 However, why is there no correlation
Conclusions
The incidence of delay in diagnosis and advanced disease for mouth and throat cancer has not altered during the past 40 years. Delay correlates with neither the stage of tumour at presentation nor survival. The most likely explanation is that some tumours are relatively silent until they are advanced.
References (24)
- et al.
Clinical characteristics and diagnostic delay of head and neck cancer: results from a prospective study in Belgium
Eur J Surg Oncol
(1996) - et al.
Lateness of diagnosis of oral and oropharyngeal carcinoma: factors related to the tumour, the patient and health professionals
Eur J Cancer B Oral Oncol
(1994) - et al.
Referral delay in diagnosis of oro/oropharyngeal cancer in Israel
Eur J Cancer B Oral Oncol
(1995) - et al.
Referral patterns of patients with oral squamous cell carcinoma, Australia
Eur J Cancer B Oral Oncol
(1992) - et al.
Prognosis and significance of STNMP and velocity of tumour growth in oral cancer
Cancer
(1982) - Visser O, Coebergh JWW, Otter R, Schouten LJ. Head and neck tumours in the Netherlands 1989–1995. In: Netherlands...
The early diagnosis of carcinoma of the mouth
Ann R Coll Surg Engl
(1981)- et al.
Who and what influences delayed presentation in breast cancer
Br J Cancer
(1998) Carcinoma of the mouth: types and degrees of malignancy
Ann J Roentgenol Radium Ther Nucl Med
(1927)- et al.
Factors delaying the diagnosis of oral and oropharyngeal carcinomas
Cancer
(1989)
Delay in the diagnosis of oral squamous cell carcinoma
Clin Otolaryngol
Head and neck carcinoma—stage at presentation
Clin Otolaryngol
Cited by (151)
Undifferentiated pleomorphic sarcoma of the venous system: A case report
2023, Annals of Vascular Surgery - Brief Reports and InnovationsInsight on nano drug delivery systems with targeted therapy in treatment of oral cancer
2023, Nanomedicine: Nanotechnology, Biology, and MedicineCritical review of clinical practice guidelines for evaluation of neck mass in adults
2022, Brazilian Journal of OtorhinolaryngologyCircular RNAs as a Diagnostic Biomarker in Oral Squamous Cell Carcinoma: A Meta-Analysis
2022, Journal of Oral and Maxillofacial Surgery