Challenges in diagnosing head and neck cancer in primary health care.

Background: Early diagnosis of head and neck cancer (HNC) will improve patient outcomes. The low incidence of HNC rendersits detection challenging for a general practitioner (GP) in primary health care (PHC).Patients and methods: To examine these challenges, our cohort consisted of all patients visiting PHC centers in the City of Helsinki in 2016. We chose 57 ICD-10 codes representing a sign or symptom resulting from a possible HNC and compared data forall new HNC patients.Results: A total of 242 211 patients (499 542 appointments) visited PHC centers, 11 896 (5%) of whom presented with a sign or symptom possibly caused by HNC. Altogether, 111 new HNCs were diagnosed within the Helsinki area, of which 40 (36%) were referred from PHC. The median delay from the initial PHC visit to the referral to specialist care was 5 days,whereby 88% of patients were referred within one month.Conclusions: Despite the low incidence of HNC and the large number of patients presenting with HNC-related symptoms, GPs working in PHC sort out potential HNC patients from the general patient group in most cases remarkably effectively. Key messages:For every head and neck cancer patient encountered in the primary health care, a general practitioner will meet approximately 6000 other patients, 100 of whom exhibit a sign or a symptom potentially caused by a head and neck cancer.Despite the low incidence of head and neck cancer, general practitioners referred patients to specialistcare effectively, limiting the median delay from the initial appointment to referral toonly five days.