Objectives: This pilot study aimed at examining the referral process for patients with high-risk disease entering the Oral Dysplasia Clinics of the BC Oral Cancer Prevention Program. The goal was to determine factors delaying the patient's initial histological assessment.
Methods: Data was collected from 40 consecutive patients by chart review and questionnaire.
Results: The study group included 9 cases with SCC, 5 with severe dysplasia and 27 with low-grade dysplasia at time of initial lesion biopsy. In 34 (85%) of these patients, the lesion was initially identified by the patient and confirmed by a dental practitioner or was diagnosed during conventional head/neck exam by the dental practitioner. Strikingly, for 50% of the patients, time to biopsy of the lesion after clinical identification was > 6 months, with the delay to biopsy > 1 year for 15 cases. Of these 15 cases, 3 were severe dysplasia. Reasons for biopsy delay included: failure of the patients themselves to seek consultation with health professionals (5/15); a prolonged decision by the clinician to ‘wait-and-see' prior to biopsy (7/15); and interim treatment of the lesion as another disease entity (3/15).
Conclusion: The data suggest that in British Columbia, dentists play a critical role in the early identification of high-risk oral lesions. At present, much of this effort is sporadic with the disease mainly being identified at advanced stage. Among possible solutions being implemented in the province are increased education of community health professionals, enhanced public awareness and improvement and recognition of the referral-to-care pathway.