The role of primary healthcare professionals in oral cancer prevention and detection

A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer

“…Overall, the results of the present study reinforce the fi ndings from earlier research 4,5,29 and suggest that many PCDs are giving due consideration to early signs in accordance with the guidelines of the National Institute for Health and Clinical Excellence (2005). 31 However, it is surprising that this important source was not quoted once by any of the participants and it is worrying that some placed greater emphasis upon classical or textbook presentations of malignancy rather than PMLs, suggesting that further training is still necessary to promote a systematic and rigorous approach early detection of PMLs.…”

“…The complexity of the judgement task often produces greater individual variation 30 and one of the great diffi culties with PMLs is the number of clinical presentations that the disease can take. 8,28 This has already been reported in the context of PMLs 5,7 and has been confi rmed by the present study.…”

“…Previous research has shown that some PCDs also lack confidence in detecting oral cancer 4,5 and although this was not found here, there were a number of comments that an extra-oral examination was beyond the dentists' expertise. In addition to the factors associated with the lesion, PCDs also stated that factors associated with the patient can infl uence their referral.…”

“…In this study, the impact of risk factors on the decision to refer and the formal recording of such habits was again considerably varied and is not dissimilar to earlier research, 6 particularly in respect of alcohol. 5 There were even a few PCDs who suggested that risk factors did not play a part in their decision making process and that the decision to refer was determined more by factors associated with the lesion, or by its clinical history.…”

“…7 Reibel 8 argues that there are three major problems in detecting PMLs and their potential for malignant transformation: the diagnoses can be subjective; not all lesions exhibiting dysplasia will eventually become malignant and some may even regress; and OSCC can develop within apparently 'normal' mucosa. 32 Earlier work has suggested that erythroplakia is not consistently identifi ed as a lesion that warrants concern, 4,5,22 even though this form of PML has fewer differential diagnoses when compared to other types of lesion and is considered to be an important sign of malignant change. 2 However, the results of this study would suggest that many of the PCDs are giving due concern to erythroplakia and increase their index of suspicion accordingly should this or a speckled presentation be found.…”