"Head and neck cancer is relatively rare, and screening the general population would be impractical," says coauthor David O. Wilson. "However, the patients at risk for lung cancer whom we would refer for the newly recommended annual screening are the same patients that our study shows also likely would benefit from regular head and neck cancer screenings." (Credit: iStockphoto)

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Should heavy smokers get ‘head and neck’ screening?

The people most at risk for lung cancer are also those most at risk for head and neck cancer. It makes sense that combined screenings would likely improve early detection and survival, say researchers.

In an analysis published in the journal Cancer, the team provides a rationale for a national clinical trial to assess the effectiveness of adding examination of the head and neck to lung cancer screening programs.

“When caught early, the five-year survival rate for head and neck cancer is over 83 percent,” says senior author Brenda Diergaarde, assistant professor of epidemiology at University of Pittsburgh’s Graduate School of Public Health and member of the University of Pittsburgh Cancer Institute.

“However, the majority of cases are diagnosed later when survival rates generally shrink below 50 percent. There is a strong need to develop strategies that will result in identification of the cancer when it can still be successfully treated.”

Head and neck cancer

Head and neck cancer is the world’s sixth-most common type of cancer. Worldwide every year, 600,000 people are diagnosed with it and about 350,000 die. Tobacco use and alcohol consumption are the major risk factors for developing the cancer.

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The early symptoms are typically a lump or sore in the mouth or throat, trouble swallowing, or a voice change, which are often brushed off as a cold or something that will heal. Treatment, particularly in later stages, can be disfiguring and can change the way a person talks or eats.

Diergaarde and her team analyzed the records of 3,587 people enrolled in the Pittsburgh Lung Screening Study (PLuSS), which consists of current and ex-smokers aged 50 and older, to see if they had a higher chance of developing head and neck cancer.

In the general US population, fewer than 43 per 100,000 people would be expected to develop head and neck cancer annually among those 50 and older. Among the PLuSS participants, the rate was 71.4 cases annually per 100,000 people.

Annual screenings

Recently, the US Preventive Services Task Force, as well as the American Cancer Society and several other organizations, recommended annual screening for lung cancer with low-dose computed tomography in people 55 to 74 years old with a smoking history averaging at least a pack a day for a total of 30 years. The recommendation came after a national clinical trial showed that such screening reduces lung cancer mortality.

“Head and neck cancer is relatively rare, and screening the general population would be impractical,” says coauthor David O. Wilson, associate director of UPMC’s Lung Cancer Center.

“However, the patients at risk for lung cancer whom we would refer for the newly recommended annual screening are the same patients that our study shows also likely would benefit from regular head and neck cancer screenings. If such screening reduces mortality in these at-risk patients, that would be a convenient way to increase early detection and save lives.”

Diergaarde’s team is collaborating with otolaryngologists to design a national trial that would determine if regular head and neck cancer screenings for people referred for lung cancer screenings would indeed reduce mortality.

Additional researchers contributed to the study from the University of Minnesota.

The National Institutes of Health funded the work.

Source: University of Pittsburgh

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