Detection of tongue cancer in primary care

Background: The incidence of tongue cancer is increasing, and survival has not improved since the majority of patients present nr an advanced stage. P atient delay has remained the same over the years and is difficult to influ ence. Much less is known about the delay in diagnosis caused by physicians and dentists. Aim: To investigate the detection of tongue cancer in primary care in North ern Finland and to examine the consultation prevalence of oral symptoms in primary care in Finland Study: Analysis of data from medical records of tongue cancer patients kept between 1 January 1974 and 31 December 1994 for the general health insuran ce scheme. Setting: The two northernmost provinces of Finland (population of 700 000). Method: Data were collected an demographic and clinical variables and on th e first medical visit on 75 tongue cancer patients. In addition, primary ca re physicians recorded all patient visits during four weeks in 25 health ce ntres randomly selected throughout Finland in 1996. Results: At the initial visit, the tongue cancer patient war correctly refe rred for further examinations in 49(65%) cases. In 12 (16%) of cases the pa tient was not referred but was scheduled for a follow-up visit, and was nei ther referred nor followed-up in 14 (1996). When compared with the referred patients the median professional delay was somewhat longer for the unrefer red patients bur increased dramatically if no follow-up was arranged (0.6 m onths [range = 0.1-2.4] versus 1.2 [range = 0.3-2.2] versus 5.2 [range - 0. 7-18.2], P<0.001). Compared with the referred patients the adjusted relativ e hazard of death for the non-referred followed-up patients was 1.4 (95% co nfidence interval [CI] = 0.31-6.5) and that for the non-referred followed-u p patients 6.3 (95% CI = 1.7-22.9). The high-risk patients included those t hat had sought an early professional evaluation those who mane the appointm ent for a completely different reason and only mentioned the symptom sugges tive of cancer incidentally, those that had a small ulcerative lesion, and blue-collar workers. Oral Symptoms were a rare cause of visits (0.55% of al l visits) in primary care in Finland. Conclusion: Misdiagnosis of tongue cancer at the initial professional evalu ation often leads to a fatal delay if the patient is left without any follo w-up.