With oral cancer on the rise in the UK, Debbie Herbst discusses the importance of an early diagnosis.
Oral cancer, comprising cancer of the lips, tongue, mouth (gums and palate), tonsils and the oropharynx, is on the rise in the UK.
Data published by Cancer Research UK highlights that oral cancer cases have increased by 68% in the past 20 years, and that in 2020, 2,702 people died due to the disease.
The same charity’s findings indicate that approximately 90% of oral cancer cases are linked to lifestyle factors. Smoking in particular is linked to an estimated 65% of cases. Other factors include alcohol consumption and human papilloma virus (HPV).
Unfortunately, Covid-19 has affected dental professionals’ abilities to diagnose patients, both when it comes to a lack of in-person examinations, and in causing a backlog and delay in appointments.
While it has still been possible to refer patients for suspected oral cancer, it hasn’t been possible to examine all patients who may be unaware of symptoms such as lesions.
As a result, only patients concerned about such symptoms, who have subsequently visited their practice, have likely been referred.
At the DDU, we opened 104 files between January 2013 and August 2020 relating to oral cancer. There were 69 claims and 35 complaints.
In 65 cases, the dental professional allegedly failed to check the patient for oral cancer during their check-up, didn’t diagnose a suspicious lesion, or there was a delay in referring the patient to a specialist.
What to do if you suspect a patient may have oral cancer
Although a dental professional might not see a case of oral cancer during their career, it’s still important to know the signs and respond accordingly.
Firstly, dental professionals who are responsible for the care of a patient should ensure they are aware of relevant risk factors and record any preventative advice given.
Advice relating to smoking, alcohol and other lifestyle factors may be appropriate. It’s important to explain why this is relevant if the patient appears unwilling to share this information.
Documenting findings and keeping accurate and up-to-date records and reports is also vital. This might include taking photographs as they allow for the possibility of monitoring changes.
Also, consider the use of mouth maps and record information such as palpations of the lymph nodes in the neck, the duration of symptoms, and the size, site, shape and texture of lesions.
In doing this, it’s easier to provide a justification for the actions you take.
If a patient is high risk and has particular symptoms but no obvious problems, getting a second opinion is sensible. Arranging urgent onward referrals by the two-week suspected oral cancer pathway is appropriate.
Understand the signs
It is good practice to follow up with hospitals to make sure they have received referrals and are handling them. You should confirm that appointments with specialists have been organised.
The GDC recommends undertaking CPD in improving early detection of oral cancer. This will ensure dental professionals are regularly refreshing their skills and knowledge in the area. NICE has also published guidelines on how to recognise the signs of oral cancer.
To conclude, rising cases of oral cancer vindicate the importance of an early diagnosis and making appropriate timely referrals.
Spotting the warning signs and making an early diagnosis often means that treatment can be minimally invasive, and they may be able to avoid the need for complex operations and radio/chemotherapy.
As well as making sure patients receive care as effectively as possible, the information and advice given above can help to ease the worry of a complaint or claim arising as a result of a late or missed diagnosis.
Case study
DDU member Dr Jasleen Batra discovered a malignant lump under a patient’s jaw during a routine dental appointment.
Being able to spot this quickly allowed Dr Batra, a fifth-year student at the time, to make the appropriate referral. The patient was then diagnosed with cancer originating from the tonsils, and has now been given a good prognosis.
This shows the importance of knowing what to look out for. Have courage in your convictions when it comes to urging further tests and referrals.
Dr Batra says: ‘Oral cancer screenings are essential and are now routine every time you see a dentist. However, checking at home is so simple.
‘I’m so glad the patient came to see me when he did and that he is doing well. I was just doing my job. I hope his story creates awareness that may save lives in the future.’
For more information, please visit www.theddu.com.
