Head and neck cancers are a significant public health concern. The United States alone reports approximately 46,000 new head and neck cancers each year, with an estimated 10,000 deaths from these cancers.1 From a medicolegal perspective, delayed or missed diagnosis of oral malignant diseases, particularly the highly metastatic oral squamous cell carcinomas, can result in sizable damages claims. This is due to the impact of oral cancer on the cost of medical care, pain and suffering, possible disfigurement, lost income, impact on the quality of life, and possible loss of life.2 Plaintiffs’ recovery for dental malpractice lawsuits based on oral cancer can range from $1.03 million to $3.5 million, with failure to perform a biopsy or failure to refer being common allegations in dental negligence litigation.2,3
Long-term oral complications can arise in cancer survivors, such as osteonecrosis of the jaw, which includes medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN).2 Osteonecrosis is a severe complication associated with cancer treatments, including radiation and cancer medication. Osteonecrosis is defined as the death of bone cells and structure due to decreased blood flow and can present in dentistry when the jawbone is exposed.4,5 Most osteonecrosis cases occur after invasive dental procedures, such as tooth extractions. Osteonecrosis is a leading cause of potential morbidity and mortality in surviving cancer patients, and its complications are commonly involved in dental malpractice litigation.2,5
This highlights the need for health care practitioners to recognize and identify head and neck premalignant and malignant diseases through continuous training and education, in order to prevent and manage cancer growth and potential complications resulting from head and neck cancer therapy. It is essential to develop appropriate approaches to achieve a more definitive oral cancer diagnosis and to create strategies to prevent osteonecrosis in cancer survivors. Where there is an uncommon or unusual presentation of a disease or complication, dental and other health care providers should consult with other dental specialists or refer to medical providers who have additional training and experience.
COMMON LEGAL ISSUES RELATED TO HEAD AND NECK CANCER DIAGNOSIS
Delayed diagnosis of oral squamous cell carcinoma and head and neck cancers
Head and neck cancers are often at an advanced stage when initially diagnosed. Either patient delay or professional delay can cause such a delay in diagnosis.6 Patient delay in diagnosis refers to the period between the onset of the patient’s symptoms and the patient receiving an initial professional evaluation.7,8 The delay by the dental professional is defined as the time between the dentist’s first consultation with the patient and the date of the histopathologic diagnosis, including if and when no treatment or inappropriate treatment has occurred.9,10 The greater the delay in diagnosis and later the onset of treatment, the more advanced ...