Sir, we conducted a retrospective audit of the urgent suspected cancer (USC) referrals to our oral medicine department over a 12-month period. The USC pathway fast-tracks referrals for potential malignancies into secondary care, to allow rapid diagnosis and management, with the goal of improving outcomes and survival rates. The National Institute for Health and Care Excellence (NICE) published guidance, 'Suspected cancer: recognition and referral' (NG12), which outlines four signs and symptoms which should result in a USC referral.1

The results indicated poor adherence with NICE guidance with only 12% of referrals meeting criteria. The majority of referrals came from general dental practitioners (GDPs) with 12% of referrals made by one GDP and over a quarter from six particular GDPs. After examination by an oral medicine consultant, 17% of patients were diagnosed with normal anatomy, 15% with frictional keratosis and 9% with oral lichen planus.

The literature shows the diagnostic yield of malignancy is typically less than 10%.2,3,4 Conversely, this audit found 0% of USC referrals made directly to oral medicine were of a true malignant or dysplastic nature. It should be noted that patients with malignant conditions during this time entered the service either through maxillofacial pathways or inappropriate alternative pathways to oral medicine.

The findings of this audit suggest a higher level of inappropriate USC referrals to our oral medicine department compared to other units. The department has reflected on the reasons for such high levels of inappropriate referrals and feel that they may indicate a lack of knowledge or awareness of the NICE guidance. Additionally, there may be need for revision of anatomical variants and common oral medicine conditions among referrers. The findings may also reflect the increasingly medico-legal environment and the heightened vigilance of primary care practitioners. This level of caution should be welcomed by all and we do not wish to discourage referrals. However, it has to be considered how inappropriate referrals could impact on waiting times for patients whose conditions are truly malignant and for whom rapid diagnosis and management is crucial.