The article presents an audit on urgent referrals for suspected head and neck cancer in 2144 patients.
Only 8.6% of cases proved positive for head and neck cancer. The Scottish Referral Guidelines were adhered only in 55.1% of cases.
Interestingly, the authors quote that the majority of head and neck cancers are detected via routine routes! The most common referrals were for hoarseness and neck lump. In 38.5% of cases, X-ray of the chest was done prior to the referral in 120 patients and showed abnormality in only four, this being unrelated to the referral. None altered the patient management. The authors calculate this to cost £7531 and advise that this imaging can be removed from the Scottish Referral Guidelines. The pick-up rate for head and neck cancer is the lowest for 16 tumour types included in the study. This may be due to difficulties in visualising the site at primary care level, compared to much higher pick-up rates in urgent breast and urology referrals. A pick-up rate of only one in 11 urgent suspected head and neck cancer referrals is not ideal when the current resources are limited, but cancer should not be missed. Ongoing education in this field would help.
