Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay?

Gómez, Isabel Neira; Warnakulasuriya, Saman; Pi, Varela-Centelles; López‐Jornet, Pía; Suárez‐Cunqueiro, María Mercedes; Dios, Pedro Diz; Seoane, Juan

doi:10.1111/j.1601-0825.2009.01642.x

Cited by 163 publications

(170 citation statements)

References 95 publications

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“…Observa-se que frequentemente os usuários com essa doença são acolhidos como demanda espontânea, sendo que, em muitos casos, iniciase na atenção primária um fenômeno de sucessivos atrasos, do diagnóstico à referência, que acabam por adiar as possibilidades de abordagem precoce e consequentemente limitam as chances de sobrevida dos pacientes 5,6,7 .…”

Section: Estratégia Saúde Da Família E Os Centros De Especialidades Ounclassified

“…Estudos que analisam o atraso diagnóstico do câncer bucal mostram limitações semelhantes às observadas no Brasil, mesmo em nações com alto índice de desenvolvimento humano (IDH) e com sistemas de saúde pública historicamente mais consolidados e organizados que o modelo brasileiro 6,7,39 .…”

Section: Estratégia Saúde Da Família E Os Centros De Especialidades Ounclassified

“…Estudos apontam diversos fatores que limitam o enfrentamento da problemática do câncer da boca, e dentre estes são descritas as dificuldades de estabelecimento de políticas públicas dirigidas aos principais fatores de risco relacionados à ocorrência de neoplasia maligna oral 1,2,5,6 . Além disso, fatores relativos ao paciente e/ou ao profissional, juntos ou isolados, contribuem para a demora no diagnóstico do câncer de boca e suas consequências 7,8 .…”

Section: Introductionunclassified

“…Embora a doença ocorra em uma topografia amplamente acessível ao exame clínico e onde, supostamente, as alterações iniciais neoplásicas seriam facilmente detectáveis, estudos acumulam evidências de que esse tipo de câncer ainda é diagnosticado muito tardiamente e, como consequência, observa-se comumente a necessidade de tratamento mutilador 7,8,9,10 .…”

Section: Introductionunclassified

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Abordagem do câncer da boca: uma estratégia para os níveis primário e secundário de atenção em saúde

et al. 2012

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O avanço verificado no enfrentamento de neoplasias malignas por meio dos sistemas de saúde envolve melhorias nas áreas de vigilância, organização de redes de assistência, programas específicos voltados às prevenções primária e secundária e, obviamente, aos avanços técnico-científicos que caracterizam a abordagem diagnóstica e terapêutica. Embora seja notável o reconhecimento de avanços no manejo de neoplasias malignas em todas as áreas citadas, o câncer da boca permanece com indicadores de morbidade e mortalidade que parecem não acompanhar o acúmulo científico no conhecimento da doença. O presente manuscrito objetiva discutir os motivos desse descompasso, a necessidade de reorientação de prioridades na abordagem do câncer da boca e sua efetivação como política pública de saúde.

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Section: Estratégia Saúde Da Família E Os Centros De Especialidades Ounclassified

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Abordagem do câncer da boca: uma estratégia para os níveis primário e secundário de atenção em saúde

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“…Therefore, risk stratification using clinical and pathological criteria is inadequate. 9 Thus, identification of biomarkers that can differentiate high-risk lesions from more benign lesions is of critical importance for early intervention in high-risk patients. In addition, major thrust is being laid on assessing the clinical applicability of biomarkers in predicting response to therapy, recurrence, survival, and overall prognosis.…”

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Loss of DLC1 is an independent prognostic factor in patients with oral squamous cell carcinoma

et al. 2012

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Deleted in liver cancer (DLC1), a Rho GTPase-activating protein, was observed to be differentially expressed in oral squamous cell carcinoma in comparison with normal tissues using tissue proteomics. In the current study, we investigated the clinical significance of loss of DLC1 expression in different stages of development of oral squamous cell carcinoma to determine its potential as a biomarker for oral dysplasia and prognosis of oral squamous cell carcinoma. Immunohistochemical analysis of DLC1 expression was carried out in oral squamous cell carcinoma patients (n ¼ 214), dysplasia (n ¼ 51), hyperplastic squamous mucosa (n ¼ 45), and histologically normal oral tissues (n ¼ 80), and correlated with clinicopathological parameters and disease prognosis over 91 months for oral squamous cell carcinomas. Loss of DLC1 expression was observed in oral squamous cell carcinoma (64%), oral dysplasia (31%), hyperplastic squamous mucosa (22%), and normal mucosa (16%). Significant loss of DLC1 expression was observed in oral squamous cell carcinomas as compared with dysplasia (Po0.001, odds ratio ¼ 3.8, 95% CI ¼ 2.0-7.3), suggesting it may be an important event involved in cancer progression. Among oral squamous cell carcinomas, the loss of DLC1 expression was significantly associated with poor prognosis (P ¼ 0.021, hazards ratio (HR) ¼ 1.8, 95% CI ¼ 1.1-2.9). Multivariate analysis revealed loss of DLC1 (P ¼ 0.023, HR ¼ 2.1, 95% CI ¼ 1.2-3.9) and histopathological grade (P ¼ 0.015, HR ¼ 1.7, 95% CI ¼ 1.1-2.7) to be independent predictors for disease-free survival in oral squamous cell carcinoma patients in comparison with known prognostic factors, viz. tumor stage, nodal status, and overall stage. Loss of DLC1 expression emerged as an important biomarker for predicting patients diagnosed with oral dysplasia at high risk of transformation upon future validation in longitudinal studies. Loss of DLC1 expression is a poor prognostic marker for oral squamous cell carcinoma patients.

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Association Between Antibiotic Prescribing and Time to Diagnosis of Head and Neck Cancer

Gallogly,

Armstrong,

Brinkmeier

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceDiagnostic delay can negatively affect patient outcomes in head and neck cancer (HNC). Neck mass and other symptoms of undiagnosed HNC may be treated with antibiotics, delaying diagnosis and treatment, despite current clinical practice guidelines.ObjectiveTo investigate temporal trends, associated factors, and time from symptom onset to antibiotic prescribing before an HNC diagnosis.Design, Setting, and ParticipantsA retrospective cohort study was conducted using data obtained from a deidentified electronic health records data set from January 1, 2011, to December 31, 2018. Patients with HNC enrolled in the data set for at least 1 year before diagnosis date determined by either 1 inpatient encounter or first of 2 outpatient encounters within 6 months were included. Data analysis was conducted from May 1 to November 9, 2022.ExposureAntibiotic prescription within 3 months before HNC diagnosis date.Main Outcomes and MeasuresThe primary outcome was days from the first documented symptom to HNC diagnosis.ResultsThe cohort included 7811 patients with HNC (4151 [53.1%] men, mean [SD] age, 60.2 [15.8] years). At least 1 antibiotic was prescribed for 1219 patients (15.6%) within 3 months before HNC diagnosis. This represented an increase over the 8.9% prescribing rate during the baseline period 12 to 9 months before diagnosis. The rate of antibiotic prescribing within 3 months before diagnosis did not change significantly over time (quarterly percent change, 0.49%; 95% CI, −3.06% to 4.16%). Patients receiving an antibiotic prescription within 3 months of an HNC diagnosis had a 21.1% longer time between symptom onset and HNC diagnoses (adjusted rate ratio [ARR], 1.21; 95% CI, 1.14-1.29). Compared with diagnosis by otolaryngologists, primary care/internal medicine physicians were most likely to prescribe antibiotics for patients who were diagnosed with a presenting symptom (adjusted prevalence ratio, 1.60; 95% CI, 1.27-2.02). In patients presenting with neck mass/swelling, those presenting with other symptoms were more likely to have longer intervals from symptom onset to diagnosis (ARR, 1.31; 95% CI, 1.08-1.59).Conclusions and RelevanceThe findings of this cohort study suggest there is an increased rate of antibiotic prescription in the 3 months before HNC diagnosis, which is associated with an increased time to diagnosis. These findings identify an area for improvement in HNC care and guidelines.

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Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay?

Cited by 163 publications

References 95 publications

Abordagem do câncer da boca: uma estratégia para os níveis primário e secundário de atenção em saúde

Abordagem do câncer da boca: uma estratégia para os níveis primário e secundário de atenção em saúde

Loss of DLC1 is an independent prognostic factor in patients with oral squamous cell carcinoma

Association Between Antibiotic Prescribing and Time to Diagnosis of Head and Neck Cancer

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