Is diagnostic delay related to advanced‐stage oral cancer? A meta‐analysis

Abstract

Diagnostic delay in oropharyngeal cancer may be associated with poor prognosis. As controversy exists on this topic because of contradictory results, the aim of this study was to perform a systematic review of the relationship between total diagnostic delay and advanced disease stages. A systematic search of MEDLINE, EMBASE, and ISI proceedings was made to identify observational studies that provided relative risks (RRs) and 95% confidence intervals (CIs) for patients with confirmed pathological diagnosis. The outcome of interest was disease stage (TNM classification), while the exposure of interest was the total diagnostic delay. The study-specific adjusted log RRs for cohort studies were weighted by the inverse of their variance to compute a pooled RR and its 95% CI. The fixed-effects pooled RR of advanced stages of oropharyngeal cancer when diagnostic delay is present was 1.32 (95% CI: 1.07-1.62). This association was stronger when the analysis was restricted to oral cancer (pooled RR: 1.47; 95% CI: 1.09-1.99) and when delay was longer than 1 month (pooled RR: 1.69; 95% CI: 1.26-2.77). The probability for patients with delayed diagnosis to present an advanced-stage tumour at diagnosis was significantly higher than that of patients with no delay in diagnosis. However, new prospective studies with strict methodology are needed to shed more light on this association.

Total Diagnostic Delay in Oral Cancer may be Related to Advanced Disease Stage at Diagnosis

“…4 These findings are in contrast to a systematic review of 27 studies by Goy et al, 5 also published in 2009, which found no consistent positive association between diagnostic delay in any of the head and neck cancer sites analyzed (all head and neck sites combined, oral cavity, pharynx, and larynx) and advanced-stage disease. Goy et al 5 decided that a quantitative synthesis using meta-analysis could not be conducted because of the heterogeneity of the studies.…”

“…This study's objective was to perform a systematic review and meta-analysis to investigate whether total diagnostic delay was associated with advanced disease stages. 4 Total diagnostic delay refers to the period elapsed between the first symptom or sign and the definitive diagnosis. There are generally 2 to 3 stages of total diagnostic delay.…”

False negative result

“…1,2 The point is clearly made that absence of bleeding on probing is a very significant indicator for periodontal stability. 2 Lack of gingival bleeding also suggests stability. Clinical attachment loss (CAL) is stated as a measure of periodontal disease history rather than current activity.…”

Textbook of Plastic and Reconstructive Surgery

“…Despite this, half of OPSCC diagnoses are made at stages III or IV, which have survival rates of 20-50% depending on the subsite (Gomez et al, 2010;Gomez et al, 2009). As well as improving survival rates (by up to 90% for early stage cancers) (Bagan, Sarrion & Jimenez, 2010), evidence suggests that an early diagnosis can also decrease the morbidity associated with treatment (Gomez et al, 2010).…”

“…Tumour staging at the time of OPSCC diagnosis is recognised to be an imperative prognostic marker for survival (Gomez et al, 2009). Despite this, half of OPSCC diagnoses are made at stages III or IV, which have survival rates of 20-50% depending on the subsite (Gomez et al, 2010;Gomez et al, 2009).…”