Factors contributing to delayed diagnosis in nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) can be difficult to diagnose. Not only is th e post-nasal space (PNS) inaccessible to examination, it is frequently occu pied by normal lympho-epithelium which can make differentiation from NPC di fficult. Together with its frequent atypical presentation, it is not surpri sing that the diagnosis is missed or delayed. This is undesirable as the treatment of early NPC carries an excellent prog nosis. The aim of this study is to ascertain the extent of the problem of m issed or delayed diagnosis and to study the factors responsible. This was a retrospective study of all newly diagnosed patients with NPC from the Sing apore General Hospital and treated in the Department of Therapeutic Radiolo gy in the year 1996 (1 January-31 December). A total of 126 patients were studied. Eighteen patients (14.3 per cent) wer e found to have delayed diagnosis of more than a month. The delay ranged fr om 1.2 to 25 months (mean 7.2 months). Factors identified which contributed to delayed diagnosis included i) Clinicians not considering a diagnosis of NPC ii) Clinicians suspecting NPC but misled by the results of investigati ons iii) Patients refusing investigation or defaulting follow-up. Nearly a fifth of patients with NPC had delayed diagnosis. Many of the fact ors responsible for the delays appear to be preventable by better patient e ducation and counselling, doctors having sharper clinical acument and skill s in NPC diagnosis and the hospital administration having a system of track ing down high risk patients who default.