Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist.

Delays in the diagnosis of oral cancer have been the subject of several cases recently reported in the media. Different types of delays include patient delays, doctor delays and system delays. Although diagnostic delays in primary care constitute a minority of these cases they are potentially modifiable and therefore an important aspect of care to address. GDPs need to be aware of several different factors when assessing the risk for oral cancer including the changing epidemiology of oral cancer and new trends in tobacco consumption, for example the increasing use of waterpipes (shishah/hookah). However several problems in fully assessing patients for oral cancer have been reported. These include time constraints, a lack of remuneration and little training in assessing risk factors and conducting a soft tissue examination. This article reviews these issues and puts forward the case for oral cancer detection as a compulsory CPD topic and a national oral cancer checklist as a tool to ensure all aspects of the oral cancer assessment are considered, which can then be audited and remunerated.