The two-week wait cancer initiative on oral cancer; the predictive value of urgent referrals to an oral medicine unit

Abstract

Background: The two-week wait cancer initiative was designed to speed up referral of patients suspected of having cancer. The National Institute of Clinical Excellence (NICE) has issued guidelines for head and neck cancers warranting urgent referral. Objective: To look at the appropriate use of the two-week wait/urgent referrals by measuring the proportion of urgent referrals found to have cancer, to assess the sensitivity of the clinical guidelines and to explore how practitioners used them in primary care. Method: Collection and analysis of urgent referral letters and the clinic outcome for urgently referred cases over a one-year period in an oral medicine department. Screening of the biopsy service database to reveal any routine referrals subsequently found to have cancer. Results: None of the routine referrals but eight percent of all urgent patients were found to have cancer, equating to 24% of the group in which malignancy was suspected. The predictive value of referring a case as suspected of oral cancer/with cancer symptoms was low, estimated at 7.9%. Conclusion: The referral guidelines on oral cancer symptoms developed by NICE may need further revision. Moreover, development of other appropriate adjuncts that aid visual inspection for the detection of oral cancer may improve the sensitivity of positive detections in primary care.