LETTER TO EDITOR
Year : 2015 | Volume
: 22 | Issue : 2 | Page : 124--125
Can the diagnostic delay of oral cancer by healthcare practitioners be prevented? Who should bear the blame of delay?
Gaurav Sharma1, Archna Nagpal2,
1 Department of Oral Medicine and Radiology, S.R. Dental College, Faridabad, Haryana, India
2 Department of Oral Medicine and Radiology, PDM Dental College, Bahadurgarh, Haryana, India
Dr. Gaurav Sharma
Department of Oral Medicine and Radiology, S.R. Dental College, Faridabad, Haryana
|How to cite this article:|
Sharma G, Nagpal A. Can the diagnostic delay of oral cancer by healthcare practitioners be prevented? Who should bear the blame of delay?.J Fam Community Med 2015;22:124-125
|How to cite this URL:|
Sharma G, Nagpal A. Can the diagnostic delay of oral cancer by healthcare practitioners be prevented? Who should bear the blame of delay?. J Fam Community Med [serial online] 2015 [cited 2019 Nov 13 ];22:124-125
Available from: http://www.jfcmonline.com/text.asp?2015/22/2/124/155398
The foremost reason for the deferral in the clinical presentation of patients with oral cancer is the lack of awareness of patients and even practitioners.  The underlying cause of the lack of awareness by the patient and the delay in diagnosis is the poor public perception of oral cancer, patients' initial interpretation of the symptom, fear of diagnosis, illiteracy, what is going on in the life of the patient during this period of delay, and subjective priority for seeking help for the symptoms.  Patient awareness programs are emphasized aggressively through advertisements in print and electronic media, pictorial warnings, and anti-tobacco messages. These interventions together with noninvasive self-examination of the mouth are considered critical components of oral cancer awareness and the vital role of the patient in its diagnosis. Self-detection should be encouraged as a means of increasing awareness of oral cancer and an effective and economic tool for early detection of potentially malignant lesions.
One ignored factor is the lack of importance given by general practitioners to oral cancer. A general dentist and physician see no more than an average of 10 oral cancer patients during his or her professional life.  This creates a problem that can only be overcome through collaboration between practitioners and oncologists to ensure an early and timely diagnosis, even if no biopsy is done. The lack of facilities, which is the major reason for the delay in the diagnosis of oral cancer in rural areas, can be overcome by the education of healthcare practitioners. It will improve their diagnostic competence to detect the malignant changes in the oral cavity and an appreciation of the urgency to follow with an immediate referral. Systematic, high-quality, and theory-driven research on the reasons of delay in the presentation is an immediate priority for the practitioner, as there appears to be little research in this area.  The lack of awareness of the practitioner is by and large the result of inexperience, lack of suitable investigations, inadequate record-keeping, inefficient follow-up, failure to mention or refer. Also another contributing factor because of the perceived rarity of the condition, is the lack of exposure of the practitioner to malignant changes in the oral cavity.  Continuing dental and medical education should have incorporated in them systems of referral to help the healthcare practitioner deal with cancerous changes, for the practitioner is generally caught between not over-investigating or making inappropriate referrals and the possibility of misdiagnosing oral cancer. The absence of change in the clinical symptoms and signs in a patient or any resolution of oral lesion or mucosal changes after 2-3 appointments should be a source of worry to warrant immediate steps by the physician to find a solution.
The authors would like to suggest that there should be an aggressive approach toward the re-education of the health care workers. However, as a first step, health care workers should accept the fact that they sometimes unintentionally disregard and miss the diagnosis of cancerous changes. The problem is partly because of the healthcare worker's general perception of oral cancer as frank ulceration or ulceroproliferative growth coupled with systemic signs. Various clinical presentations of cancer, especially the initial stages of a white patch or mixed red-white patch, should be explained to health care workers in all leaflets produced in continuing medical education programs. The significance of a detailed intraoral visual examination as part of a population-based screening program in decreasing the mortality rate of oral cancer in high-risk individuals has been proved in a recent Cochrane review.  There should also be periodic curriculum updates and an effective integration of knowledge of the early diagnosis of potentially malignant oral conditions in under-graduate and post-graduate medical education. Clinicians must implement a universal index of suspicion in screening for oral cancer, and avoid delay by paying particular attention to the risk indicators of tobacco or alcohol.  Finally, self-examination of the oral cavity for mucosal variations must be a constituent of every healthcare professional's education and training as well as a vital part of the general public awareness campaign.
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