Warning over sharp drop in mouth cancer referrals

Mouth cancer referrals within Scotland’s largest health board have almost halved during the coronavirus crisis, with experts warning lives may be at risk due to late diagnoses.

Figures from NHS Greater Glasgow and Clyde show that referrals dropped 46 per cent in the six months since March, compared to the previous six months.

The decrease has been linked to the drop in people seeing the dentist during the pandemic, as many mouth cancers are spotted at the early stages by dentists.

The Oral Health Foundation, which compiled the data, found a 30% decrease in Scotland overall, however only two Scottish health boards responded to its request for information.

Across the UK, the number of people being referred for possible mouth cancer fell by a third (33%).

Dr Nigel Carter OBE, chief executive of the foundation, warned that lives are at risk as he highlighted the importance of self-checks at home.

He said: “Regular dental check-ups and GP appointments are the main routes for identifying the early stages of mouth cancer. We fear that without access to dental and wider health professionals, that many mouth cancer cases will go undiagnosed.

“A person’s quality of life after being treated for mouth cancer, as well as their chances of beating the disease, is highly dependent on the time of diagnosis. By allowing so many potential mouth cancers to go untreated, there is a real danger of more people losing their life to the disease.

“While dental and GP visits remain disrupted it is important that everybody knows how to check themselves for mouth cancer. If you notice anything out of the ordinary, contact your dental practice, who will be able to see you as an emergency patient.”

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The figures show that referrals in NHSGGC fell from 427 in the six months before covid-19 to 230 in the six months after.

In Ayrshire and Arran, the numbers dropped from 288 to just 270.

According to the charity, Covid-19 has limited dental practice activity to 20% of what is usually expected, with more than half of UK adults having had check-ups postponed or cancelled.

The British Dental Association estimates that there is a backlog of 10 million appointments due to dental practices being forced to shut down during the pandemic.

Research by the foundations indicates that one-in-six people have experienced at least one of the potential early warning signs of the disease.

These can include mouth ulcers lasting three weeks, red or white patches in the mouth, unusual lumps and swellings, and persistent hoarseness.

Mouth cancer can appear on the tongue, tonsils, gums and lips.

Stuart Caplan, who was diagnosed with with tongue cancer in 2012, urged people to get help if they feel something is not right.

The father, from Marble Arch, lost two-thirds of his tongue to the disease but says acting quickly was the key to him beating it.

He said: “Mouth cancer is a hidden cancer, unlike a lot of cancers where there are obvious symptoms.

“People think ‘oh it’s only a mouth ulcer, it’ll pass’. It’s easy to just put a mouth ulcer treatment on and ignore it, and without visiting a dentist regularly it’s likely to get missed.

“If it’s not normal for you, get it checked immediately, especially you have had something for a few weeks. Cancer symptoms don’t go away. That’s the litmus test. Go and see a dentist or hygienist.”

Figures collected by the Oral Health Foundation show that 8,722 people in the UK were diagnosed with the disease last year, increasing by 97% since 2000.

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Mouth cancer cases in the UK have soared for the 11th year in a row and have more than doubled within the last generation.

A Scottish Government spokesperson said: “Throughout the pandemic, dental teams have been available to provide advice and referral for patients and all boards retained their rapid access referral pathway for patients with suspected oral cancer.

“The Scottish Dental Clinical Effectiveness Programme guidance issued on 30 March makes clear when a case should be referred to the Board’s Urgent Dental Care Centre.

“We are working to ensure NHS dental services emerge from this crisis well placed to care for the oral health of the population. We want to extend our thanks to dentists for their support and understanding over the last few months in helping to adapt and keep the public safe during a difficult situation.

“This latest phase in remobilisation comes with additional financial support, with emergency payments of £12 million per month to support dental incomes and an additional £2.75 million per month as specific sectoral support. We also continue to supply free PPE to dental practices for NHS patients, worth £8 million to date.”

A spokesperson for NHSGGC added: “Without the usual flow of patients through dental surgeries this year because of Covid, there has been a reduction in referrals to us from dentists for patients with a suspicion of mouth cancer. However, throughout the pandemic, NHS Greater Glasgow and Clyde have continued to receive referrals for patients with an urgent suspicion of cancer and these patients have been triaged and treated appropriately.”


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