Suspected cancer (red flag) referrals: A review of our experience in Northern Ireland

Aim Head and neck cancer continues to represent a significant source of morbidity and mortality for patients. Alongside prevention, early recognition is key to improving patient outcomes. We aim to present our experience of suspected cancer referrals to the oral surgery/oral medicine units within a dental hospital in Northern Ireland in terms of patient demographic, referral quality, and referral outcome. Materials and Methods Patients who were referred to the oral surgery or oral medicine departments within the Queen's University Belfast Dental hospital between January and September 2018, and placed on the suspected cancer (Red Flag) pathway, had their records reviewed. Data was extracted by 2 calibrated dentists using predetermined data extraction forms. Results Overall, 377 patient referrals were identified with the majority coming from dentists (GDPs) and general practitioners (GMPs). GMP referrals were commonly via the e‐referral system (97%), and GDP via post or email (97%). E‐referrals underwent triage faster than other referral methods. Of the original referrals, 62% remained on the red flag pathway following consultant triage, and all were allocated appointments within 2 weeks. Ulcers, swellings, and white patches were the most referred lesions with just 5.5% of referrals including clinical photographs. Overall, positive predictive value (PPV) was 5.3% (8% for GDPs and 3% for GMPs). Conclusion Our department successfully met the 2‐week target in all cases. PPV does however remain low, but within recognised guidance limits, and could potentially be improved by further education of referrers and/or inclusion of a clinical photo at the time of referral.