Key points and time intervals for early diagnosis in symptomatic oral cancer: a systematic review

Lack of knowledge, understanding, and delayed attitudes towards health-seeking behavior in oral cancer patients: a qualitative pilot study

OBJECTIVE

This study aimed to explore coping strategies adopted by patients diagnosed with oral squamous cell carcinoma (OSCC) and investigate the reasons for delayed healthcare-seeking help STUDY DESIGN: Data were collected through semi-structured interviews based on the Semi-Structured Self-Regulatory Model (SRM) with participants diagnosed with advanced OSCC, between 2021 and 2023. The sample size was determined based on the saturation point. In this context, saturation refers to the point when no new issues emerge, signaling sufficient sample size. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using framework analysis.

RESULTS

The sample consisted of 15 patients, 13 male and 2 female, aged between 52 and 80 years (mean 64.5, SD ± 7.5). Four types of coping strategies causing delayed help-seeking emerged: 1) self-medication, 2) seeking medical appointments, 3) abandoning consultations (or treatment), and 4) consulting general dental practitioners. Participants believed that the disease could heal spontaneously and did not consider seeking health help immediately. Socio-economic factors and lack of knowledge on the part of healthcare professionals may have influenced the delay in the diagnosis CONCLUSION: Patients with advanced OSCC demonstrated inadequate disease awareness, oral cancer knowledge, misdiagnosis, and insufficient referrals to specialized treatments.

Primary Care Referral Delays in Oral Cancer Diagnosis: A Meta‐Analysis

Objective

To measure the primary care interval (PCI) in the diagnostic delay of oral cancer and to assess the relation of the referring physician's specialty with disease stage at diagnosis.

Methods

We meta‐analyzed reports of oral/oropharyngeal carcinomas detailing PCI start‐ and endpoints, i.e., the time needed by a primary care physician to refer a suspected oral cancer patient to a specialist.

Results

17 studies with a total of 2530 patients were eligible; nine provided data on the relative length of PCI, and 10 reported on the impact of the referring professional's specialty on oral cancer diagnostic delay. The average PCI length was slightly longer for general practitioners (GPs) (30.5 days) than for general dental practitioners (GDPs) (27.6 days), while that for the total group was 28.7 days. One‐third of the total pre‐hospital time spent on diagnosis elapses in GP practices (PCI%: 0.31 [95% CI: 0.23, 0.40]). GDPs refer their patients for treatment at earlier disease stages (TNM I‐II) than GPs (Odds Ratio: 0.58; 95% CI: 0.34–0.98).

Conclusions

Primary care accounts for a considerable pre‐hospital amount of time of what is necessary for reaching a diagnosis of oral cancer patients. This calls for enhancing early oral cancer recognition in primary care settings.

Can oral cancer screening reduce late-stage diagnosis, treatment delay and mortality? A population-based study in Taiwan

OBJECTIVE

This study evaluates the effectiveness of Taiwan's nationwide oral cancer screening programme in reducing late-stage diagnosis, treatment delays and mortality.

DESIGN

A retrospective cohort study was conducted.

SETTING

The study utilized Nationally representative datasets, including the Cancer Registry, Oral Mucosal Screening and National Health Insurance databases in Taiwan.

PARTICIPANTS

The study included patients with oral cancer diagnosed between 1 January 2010 and 31 December 2013, with follow-up through 31 December 2018. The final analysis included 16 430 patients.

INTERVENTION

The intervention was Taiwan's nationwide oral cancer screening programme which provides visual inspection and palpation of the oral mucosa.

PRIMARY OUTCOME MEASURES

The primary outcomes measured were late-stage diagnosis (stages III and IV), treatment delay (time from diagnosis to treatment >30 days) and all-cause mortality.

RESULTS

Oral cancer screening was statistically significantly associated with a reduced likelihood of late-stage diagnosis (adjusted OR (AOR)=0.85, 95% CI 0.80 to 0.91, p<0.01). However, screening was also associated with a higher likelihood of treatment delay (AOR=1.09, 95% CI 1.00 to 1.19, p=0.049). Taken together, the screening programme is associated with a slightly lower hazard of death (adjusted HR=0.94, 95% CI 0.89 to 0.99, p=0.01).

CONCLUSION

While Taiwan's nationwide oral cancer screening programme effectively reduced late-stage diagnoses and mortality, barriers to timely treatment access remain. Ensuring prompt diagnosis and treatment following screening may further enhance the survival benefits of the programme.

Knowledge, attitude, and practice in oral cancer: A national survey on 150 dental hygienists

OBJECTIVE

The aim of this study is to explore knowledge, practice, and attitude on oral cancer (OC) among a cohort of Italian dental hygienists, in consideration of their role in the field of early diagnosis.

MATERIALS AND METHODS

A cross-sectional study of 150 Italian dental hygienists was performed to assess the participant's knowledge, practice, and attitude on OC. Data were collected using a structured self-administered questionnaire (through Google Forms). The questionnaire included four sections: sociodemographic information, disease knowledge, answers related to attitudes toward OC, and a questionnaire assessing the practice of dental hygienists on oral screening.

RESULTS

Responses were received from 137 participants (83 women and 54 men). Overall, there is a good knowledge of the real risk factors among the participants (98.5%, 98.5%, and 94.2% regard smoking, alcohol, and HPV, respectively). The analysis related to the knowledge of non-risk factors, oral potentially malignant disorders, and clinical features of OC showed more heterogeneous results. Only 60% considered university education to be adequate. The totality of dental hygienists considered continuing education necessary, but despite this, only half took updating courses. Finally, 90% performed intraoral screening visits, and 95% and 69% investigated smoking and alcohol consumption, respectively.

CONCLUSIONS

Our data showed the need to implement OC training courses by re-evaluating pre- and post-graduate training programs.

Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors

The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.

Detection of oral squamous cell carcinoma in clinical photographs using a vision transformer

Oral squamous cell carcinoma (OSCC) is amongst the most common malignancies, with an estimated incidence of 377,000 and 177,000 deaths worldwide. The interval between the onset of symptoms and the start of adequate treatment is directly related to tumor stage and 5-year-survival rates of patients. Early detection is therefore crucial for efficient cancer therapy. This study aims to detect OSCC on clinical photographs (CP) automatically. 1406 CP(s) were manually annotated and labeled as a reference. A deep-learning approach based on Swin-Transformer was trained and validated on 1265 CP(s). Subsequently, the trained algorithm was applied to a test set consisting of 141 CP(s). The classification accuracy and the area-under-the-curve (AUC) were calculated. The proposed method achieved a classification accuracy of 0.986 and an AUC of 0.99 for classifying OSCC on clinical photographs. Deep learning-based assistance of clinicians may raise the rate of early detection of oral cancer and hence the survival rate and quality of life of patients.

A Mechanistic Review of Methotrexate and Celecoxib as a Potential Metronomic Chemotherapy for Oral Squamous Cell Carcinoma

The combination of low-dose methotrexate and celecoxib as metronomic chemotherapy (MCT) is a novel therapy, believed to act by modulating the immune response, inhibiting angiogenesis and its cytotoxic action, though the exact mechanism of action is unclear. Clinically, MCT was found to be very effective in delaying tumor progression in patients with head and neck squamous cell carcinoma in both curative and palliative settings. This review was aimed to give a brief insight into the mechanism of action and potential molecular alterations of MCT in the treatment of oral cancers taking into consideration the various in vivo and in vitro studies.

Challenges in the Early Diagnosis of Oral Cancer, Evidence Gaps and Strategies for Improvement: A Scoping Review of Systematic Reviews

Oral cancer is a growing problem, accounting for 377,713 worldwide new cases per year, and 177,757 deaths annually and representing a 5-year mortality rate close to 50%, which is a considerable mortality that has not decreased substantially in the last 40 years. The main cause of this high mortality is related to the diagnosis of a high percentage of oral cancers in advanced stages (stages III and IV) in which treatment is complex, mutilating or disabling, and ineffective. The essential cause of a cancer diagnosis at a late stage is the delay in diagnosis, therefore, the achievement of the objective of improving the prognosis of oral cancer involves reducing the delay in its diagnosis. The reasons for the delay in the diagnosis of oral cancer are complex and involve several actors and circumstances-patients, health care providers, and health services. In this paper, we present the results of a scoping review of systematic reviews on the diagnostic delay in oral cancer with the aim to better understand, based on the evidence, and discuss in depth, the reasons for this fact, and to identify evidence gaps and formulate strategies for improvement.

Effectiveness of Interventions to Improve Oral Cancer Knowledge: a Systematic Review

Oral cancer is prone to late-stage diagnosis, and subsequent low five-year survival rates. A small number of interventions or campaigns designed to enhance knowledge of risk factors and symptoms associated with oral cancer have been attempted in the UK, US, and some other countries. The purpose of this systematic review is to assess the effectiveness of interventions designed to improve oral cancer knowledge. We searched five databases to identify randomized controlled trials (RCTs) and non-randomized/quasi-experimental (NR/QE) studies targeting the general population or high-risk groups (tobacco users or alcohol consumers), aged ≥15 years, and reporting the outcomes of individual and/or community level interventions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. Adhering to PRISMA guidelines, 27 (eight RCTs and 19 NR/QE studies) of the 551 studies identified from the five databases met the inclusion criteria. All RCTs and nine NR/QE studies used either printed materials, health education sessions, multimedia aids, or some combinations of these tools. The other ten NR/QE studies were community-based and used mass media campaigns to increase oral cancer awareness. Overall, the majority of studies significantly improved oral cancer knowledge; however, heterogeneity in study design and variation in measurement tools made it difficult to compare outcomes. Findings suggest that individual and/or community level interventions are generally effective in increasing knowledge of oral cancer risk factors, signs and symptoms, and/or its early diagnosis and prevention strategies among the general population or high-risk groups. However, the long-term benefits of these interventions are understudied.

Tendências de Mortalidade por Câncer Bucal no Brasil por Regiões e Principais Fatores de Risco

Introdução: O câncer bucal ainda e destacado como preocupante problema de saúde publica. Objetivo: Verificar a tendência de mortalidade por câncer bucal por Região brasileira e fatores de risco, avaliando o intervalo de tempo entre o diagnóstico e o tratamento. Método: Estudo com dados secundários do DATASUS (taxa de mortalidade e tempo para tratamento) e do Vigitel (consumo de álcool e cigarro); analises de series temporais e correlações entre taxas de mortalidade (2010-2019) e consumo de álcool e cigarro (2010-2019), para idade superior a 40 anos, e analise descritiva do tempo entre diagnóstico e tratamento. Resultados: Houve aumento da tendência de câncer bucal por Regiões e sexo, com predominância para o sexo masculino. A variação percentual anual (VPA) da ingestão de álcool e o uso de cigarro foram considerados estacionários na maioria das Regiões analisadas. Ao correlacionar as variáveis, verificou-se correlação estatisticamente significativa entre taxa de mortalidade (2010-2019) e percentual de consumo de álcool (p=0,011; r=0,957), percentual de consumo de cigarro (p=0,019; r=0,936) e taxa bruta de mortalidade em homens (2019) (p=0,005; r=0,97). Verificou-se que, na maioria dos casos (74%), o tempo para início do tratamento e de mais de 60 dias. Conclusão: Embora o consumo de álcool e o tabagismo sejam fatores de risco para o câncer bucal, o presente estudo concluiu que houve aumento da mortalidade por câncer e os fatores de risco analisados permaneceram estacionários. O início de tratamento foi maior do que 60 dias a partir do diagnóstico.

Oral cancer awareness and education within the pharmacy profession

The incidence of oral cancers are rising in the UK, with early detection a significant positive prognostic factor. The Covid-19 pandemic has negatively impacted patients access to dental services, reducing a potential avenue to diagnosis. Community pharmacists are well positioned to play an expanded role in supporting earlier detection. This study seeks to identify levels of awareness and knowledge of oral cancer amongst community pharmacists, to inform development of educational resources.A cross-sectional digital survey was distributed via social media between August and September 2021. Data were collected on participant's demographics, oral cancer awareness and educational resources relevant to oral cancer. The results obtained were analysed using descriptive statistics in IBM SPSS software.61 pharmacists completed the survey. The majority were female (n = 40; 65.6%) aged 18-30 (n = 33; 54.1%). Less than half of respondents reported feeling confident in recognising risk factors (37.7%; n = 23). A substantial minority (n = 8; 13.1%) incorrectly selected fluoride toothpaste use as a risk factor for oral cancer. Most respondents correctly suggested signposting patients with signs or symptoms of oral cancer to a General Medical or General Dental Practitioner (GDP) (n = 35; 57.3%, n = 46; 75.4%). 91.8% of respondents (n = 56) would welcome an educational resource to support professional development.This study demonstrates a need for further educational resources regarding oral cancer, specifically aimed at community pharmacists. Community Pharmacists have a crucial role in efforts to improve rates of early detection of oral cancers. Work should be completed to explore the establishment of direct referral pathways from community pharmacy to secondary care.

Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer

This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3-76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61-0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.

Biomedical applications of vibrational spectroscopy: Oral cancer diagnostics

Vibrational spectroscopy, based on either infrared absorption or Raman scattering, has attracted increasing attention for biomedical applications. Proof of concept explorations for diagnosis of oral potentially malignant disorders and cancer are reviewed, and recent advances critically appraised. Specific examples of applications of Raman microspectroscopy for analysis of histological, cytological and saliva samples are presented for illustrative purposes, and the future prospects, ultimately for routine, chairside in vivo screening are discussed.

Time-to-Treatment in Oral Cancer: Causes and Implications for Survival

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

The contribution of artificial intelligence to reducing the diagnostic delay in oral cancer

Oral cancer (OC) is the sixth most commonly reported malignant disease globally, with high rates of disease-related morbidity and mortality due to advanced loco-regional stage at diagnosis. Early detection and prompt treatment offer the best outcomes to patients, yet the majority of OC lesions are detected at late stages with 45% survival rate for 2 years. The primary cause of poor OC outcomes is unavailable or ineffective screening and surveillance at the local point-of-care level, leading to delays in specialist referral and subsequent treatment. Lack of adequate awareness of OC among the public and professionals, and barriers to accessing health care services in a timely manner also contribute to delayed diagnosis. As image analysis and diagnostic technologies are evolving, various artificial intelligence (AI) approaches, specific algorithms and predictive models are beginning to have a considerable impact in improving diagnostic accuracy for OC. AI based technologies combined with intraoral photographic images or optical imaging methods are under investigation for automated detection and classification of OC. These new methods and technologies have great potential to improve outcomes, especially in low-resource settings. Such approaches can be used to predict oral cancer risk as an adjunct to population screening by providing real-time risk assessment. The objective of this study is to (1) provide an overview of components of delayed OC diagnosis and (2) evaluate novel AI based approaches with respect to their utility and implications for improving oral cancer detection.

Association between hospital interval and survival in patients with oral cancer: A waiting time paradox

BACKGROUND

In early diagnosis studies on symptomatic cancer, survival was the most recommended outcome. The magnitude and impact of the patient interval and primary care interval is well-known in oral cancer; however, the hospital interval and its influence on surviving this neoplasia are not well known.

AIMS

To quantify the interval between the first contact with the specialist and the start of treatment for patients with oral cancer and to evaluate whether there was a link between this interval and disease survival.

METHODS

We designed a hospital-based study that included 228 patients diagnosed with oral/oropharyngeal squamous cell carcinoma between 1998 and 2008 at A Coruña University Hospital (Spain) who were followed up until 2016. The data were extracted retrospectively from hospital medical charts. The study interval was defined in the context of the "pathways to treatment" model as the interval from the first specialist visit (start point) to the start of treatment (end point). We calculated the total interval (from first symptom to treatment) to evaluate the relative length of the hospital interval, and we considered the variables age, sex, location, comorbidity and tumour classification stage. Survival time was defined as the interval from the first treatment to death or censoring.

RESULTS

The median hospital interval was 20 days, with an interquartile range of 15-29.1 days. The most relevant prognostic variable was the tumour stage (III-IV: Exp. ß = 2.8, p = 0.001). The hospital interval was part of the multivariate model, and its association with mortality showed a V-shaped association, where patients with short hospital intervals (3-18 days) and those with long hospital intervals (26-55 days) had significantly higher mortality than those with medium hospital intervals (19-25 days).

CONCLUSION

The hospital interval represents a relevant interval for the patient's path towards treatment, has prognostic implications and is subject to a severity bias (waiting time paradox) that should be avoided.

The utilization of saliva as an early diagnostic tool for oral cancer: microRNA as a biomarker

Recently, dentistry presents a preventive philosophy, seeking early diagnoses and minimally traumatic treatments for patients. Cancer is known for its aggressive nature, where its signals and symptoms may only appear in advanced stages of the disease, therefore, reducing the possibility of using atraumatic treatment options and patient survival. Saliva has in its composition substances which can be used as biomarkers for disease diagnoses, one of those being microRNA. microRNAs are a group of small RNA molecules with 18-24 nucleotides which have functions such as the degradation of oncogenes transcripted mRNA. The aim of this paper is to explore all theoretical possibilities that microRNA offers as an early diagnostic tool for oral cancer. Studies show that microRNA can be directly linked with cancer gene regulation. Because microRNA is more specific to tissues and diseases than mRNA, it holds the premise of being a feasible, non-invasive, and stable biomarker for early diagnosis of oral cancer. The fact that miRNA can be found in saliva makes it an extremely affordable and feasible option as a biomarker to be used. Since it is linked to regulating functions of cancer genes, it also brings hope that in the near future, it could be used as a reliable biomarker.

Diagnostic delay and suboptimal management in persistent idiopathic facial pain and persistent dentoalveolar pain; a cross-sectional study

OBJECTIVES

The aim of this study was to explore the diagnostic and therapeutic challenges encountered by patients with persistent idiopathic facial pain (PIFP) and to investigate factors influencing its delayed diagnosis.

STUDY DESIGN

In this cross-sectional study, 34 patients with newly diagnosed PIFP were interviewed. Data about diagnostic delay, number and nature of previous consultations, and previous medical and surgical interventions were recorded. Pearson's correlation and Student t test were used to examine the differences among the variables in relation to diagnostic delay.

RESULTS

The average time between the onset of symptoms to correct diagnosis was 19.3 ± 11.1 months. Diagnostic delay was significantly longer in patient with pain localized to intraoral sites (22.6 ± 7.4) compared with patients with extraoral pain (16.1 ± 9.3). The average number of health care professionals consulted before correct diagnosis was 3.7 ± 2.3. General dental practitioners were the most commonly consulted health care professionals (n = 27; 79.4%). On average, patients were given 2.3 ± 0.24 misdiagnoses before the correct diagnosis was determined and were prescribed 3.5 ± 2.4 classes of drugs. Twenty-five patients (73.5%) underwent unnecessary surgical/dental interventions.

CONCLUSIONS

Patients with PIFP are frequently misdiagnosed, leading to prescription of ineffective medications and unnecessary investigations and surgical interventions. Educational efforts should emphasize on improving knowledge and awareness of this condition.

Porphyrinoids in photodynamic diagnosis and therapy of oral diseases

Photodynamic methods have found application not only in the treatment process as photodynamic therapy but also for the early detection of neoplastic lesions and tumors as photodynamic diagnosis. Early detection of the disease allows not only to avoid the patient’s lifetime risk but also significantly reduce the costs of anticancer therapy, which are increasing every year. There is a constant search for new and more effective photosensitizers which will provide safety in therapy while maintaining efficiency. This paper summarizes recent reports focused on the photodynamic diagnosis of oral cancers. Moreover, it shows methods of the photodynamic treatment of oral verrucous hyperplasia, erythroleukoplakia, and oral leukoplakia. The treatment of choice for these diseases is a surgical excision, which always leads to scar formation. Photodynamic therapy provides a new scar-less tool for the treatment.

Evaluation of Liquid Based Cytology for Tongue Squamous Cell Carcinoma: Comparison with Conventional Cytology

Oral exfoliative cytology is now used by general practitioners in Japan to screen for oral cancer. With conventional cytology, however, the number of cells that can be sampled is small. Moreover, cell deformation and piling of cells when preparing specimens has been reported. The purpose of this study was to compare conventional and liquid based cytology (LBC), which has been employed with increasing frequency in recent years. We believe that identifying potential pitfalls in oral exfoliative cytology will help improve diagnostic accuracy. A total of 153 patients with tongue squamous cell carcinoma who were diagnosed and treated initially at our hospital between January 2000 and December 2010 were included. Of these, 124 underwent conventional cytology, while the remaining 29 underwent LBC. Histopathological and clinical findings were used as criteria. Conventional cytology yielded a positive rate of 54.8% and LBC 79.3%, while values of 28.2% and 13.8% were obtained for a suspected positive rate, respectively. Liquid based cytology yielded a significantly higher percentage of accurate diagnoses and fewer suspected positives (p<0.05) in cases clinically classified as endophytic and those classified as ulcerative in terms of clinical growth pattern. No significant difference was observed between conventional cytology and LBC in cases of an infiltrative growth pattern, however.The present results suggest that LBC is superior to conventional cytology in achieving an accurate diagnosis based on oral exfoliative cytology. The present findings also suggest that exophytic type, and especially leukoderma type clinical growth patterns constitute pitfall cases in oral exfoliative cytology.

Diagnosis and referral delays in primary care for oral squamous cell cancer: a systematic review

BACKGROUND

The incidence of oral cancer is increasing. Guidance for oral cancer from the National Institute for Health and Care Excellence (NICE) is unique in recommending cross-primary care referral from GPs to dentists.

AIM

This review investigates knowledge about delays in the diagnosis of symptomatic oral squamous cell carcinoma (OSCC) in primary care.

DESIGN AND SETTING

An independent multi-investigator literature search strategy and an analysis of study methodologies using a modified data extraction tool based on Aarhus checklist criteria relevant to primary care.

METHOD

The authors conducted a focused systematic review involving document retrieval from five databases up to March 2018. Included were studies looking at OSCC diagnosis from when patients first accessed primary care up to referral, including length of delay and stage of disease at time of definitive diagnosis.

RESULTS

From 538 records, 16 articles were eligible for full-text review. In the UK, more than 55% of patients with OSCC were referred by their GP, and 44% by their dentist. Rates of prescribing between dentists and GPs were similar, and both had similar delays in referral, though one study found greater delays attributed to dentists as they had undertaken dental procedures. On average, patients had two to three consultations before referral. Less than 50% of studies described the primary care aspect of referral in detail. There was no information on inter-GP-dentist referrals.

CONCLUSION

There is a need for primary care studies on OSCC diagnosis. There was no evidence that GPs performed less well than dentists, which calls into question the NICE cancer option to refer to dentists, particularly in the absence of robust auditable pathways.

Shorter specialist time intervals are associated with advanced stage on symptomatic oral cancer

OBJECTIVES

As longer times from the first symptom to diagnosis and treatment of oral cancers have been linked to poorer outcomes, this study investigates the contribution of the specialist to this time (STI).

SUBJECTS AND METHODS

A series of 228 oral/oropharyngeal squamous cell carcinoma patients were retrospectively studied to determine the STI and its related factors.

RESULTS

Patients were mostly males (n = 170; 74.5%), (50.7% stages I-II), mean age = 61.4 ± 12.5 years. The STI median was 6 days (X±SD:6.8 ± 5.6 days). Time first symptom to diagnosis was 64 days (X±SD:91.0 ± 84.6 days). Univariate regression unveiled a significant association between STI and TNM stage, which was confirmed by multivariate regression.

CONCLUSIONS

Specialist time interval is a short time interval in oral cancer diagnosis, imposing a limited time burden in the context of the whole interval until diagnosis. However, there seems to be room for improvement and a possible target for future interventions to shorten STI particularly for patients at early stages after their disease has been disclosed.

"Omics" in oral cancer: New approaches for biomarker discovery

OBJECTIVES

In this review paper, we explored the application of "omics" approaches in the study of oral cancer (OC). It will provide a better understanding of how "omics" approaches may lead to novel biomarker molecules or molecular signatures with potential value in clinical practice. A future direction of "omics"-driven research in OC is also discussed.

METHODS

Studies on "omics"-based approaches [genomics/proteomics/transcriptomics/metabolomics] were investigated for differentiating oral squamous cell carcinoma,oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, oral erythroplakia from normal cases. Electronic databases viz., PubMed, Springer, and Google Scholar were searched.

RESULTS

One eighty-one studies were included in this review. The review shows that the fields of genomics, transcriptomics, proteomics, and metabolomics-based marker identification have implemented advanced tools to screen early changes in DNA, RNA, protein, and metabolite expression in OC population.

CONCLUSIONS

It may be concluded that despite advances in OC therapy, symptomatic presentation occurs at an advanced stage, where various curative treatment options become very limited. A molecular level study is essential for detecting an OC biomarker at an early stage. Modern "Omics" strategies can potentially make a major contribution to meet this need.

Adjunctive Diagnostic Techniques for Oral and Oropharyngeal Cancer Discovery

The most important prognostic factor in predicting the outcome of oral and oropharyngeal cancer (OPC) is the stage at which it is diagnosed. Only 30% of patients are diagnosed with early-stage disease. The oral health care provider performs an important role in early diagnosis of oral cancer. The conventional oral examination consists of a visual and tactile assessment of accessible oral, and head and neck structures. Any suspicious or equivocal lesion should be reevaluated within 4 weeks. Evidence supporting the use of adjunctive devices to improve the ability to screen for and identify OPCs and oral premalignant lesions remains low.

Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain. Relative contribution of patient interval

BACKGROUND

Despite continuous advances in diagnosis and therapy, oral cancers are mostly diagnosed at advanced stages with minor survival improvements in the last two decades. Both phenomena have been attributed to delays in the diagnosis. This study aims at quantifying the time elapsed until definitive diagnosis in these patients and the patient interval's contribution.

MATERIAL AND METHODS

A hospital-based, ambispective, observational study was undertaken on incident cases with a pathological diagnosis of oral squamous cell carcinoma recruited during 2015 at the Oral and Maxillofacial Surgery services of CHUAC (A Coruña) and POVISA (Vigo) hospitals.

RESULTS

74 consecutive oral cancer patients (59.5% males; median age: 65.0 years (IQ:57-74)) were studied. Most cases (52.7%; n=39) were at advanced stages (TNM III-IV) at diagnosis. The period since first sign/symptom until the patient seeks health care was the longest interval in the pathway to diagnosis and treatment (median: 31.5 days; IQR= 7.0 - 61.0) and represents >60% of the interval since symptom onset until referral to specialised care (pre-referral interval). The average interval assigned to the patient resulted to be relatively larger than the time elapsed since the patient is seen at primary care until a definitive diagnosis is reached (diagnostic interval). Median of the referral interval for primary care professionals: 6.5 days (IQR= 0.0 - 49.2) and accounts for 35% (19% - 51%) of the diagnostic interval.

CONCLUSIONS

The patient interval is the main component of the pathway to treatment since the detection of a bodily change until the definitive diagnosis. Therefore, strategies focused on risk groups to shorten this interval should be implemented in order to ease an early diagnosis of symptomatic oral cancer.