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Addition of head, neck exam to lung cancer screening may increase early detection of HNSCC
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The prevalence of head and neck squamous cell carcinoma in current and former smokers may justify adding head and neck exams to routine lung cancer screening for high-risk individuals, according to study results.
Doing so could increase early detection of and improve outcomes associated with head and neck squamous cell carcinoma (HNSCC), researchers wrote.
Brenda Diergaarde
“Early detection of head and neck cancer is associated with reduced morbidity and mortality,” Brenda Diergaarde, PhD, assistant professor of epidemiology at the University of Pittsburgh Cancer Institute, told HemOnc Today. “However, the majority of cases are detected late. It is a cancer that can be screened for relatively easily, but because it is relatively rare, screening for head and neck cancer in the general population is not practical. Screening of individuals at high-risk, however, may be effective.”
CMS issued a draft guidance in November 2014 that supports Medicare coverage of annual lung cancer screening with low-dose CT for high-risk individuals, defined as those aged 55 to 74 years who currently smoke or have quit in the past 15 years and who have a 30 pack-year smoking history.
“Cigarette smoking is one of the major risk factors for head and neck cancer, just like it is for lung cancer,” Diergaarde said. “Because annual screening for lung cancer is now recommended for [these] individuals … we started thinking about whether it would be a good idea to start screening for head and neck cancer among those individuals, as well. After all, their smoking history would put them at high risk for head and neck cancer. Plus, if they would already come in for their CT scan, they could potentially be screened for head and neck cancer right away.”
Diergaarde and colleagues evaluated data from 3,587 at-risk participants who were enrolled in the Pittsburgh Lung Screening Study. All participants were current or former smokers aged at least 50 years with a ≥12.5 pack-year smoking history.
During 32,201 person-years of follow-up, 23 (0.64%) of the participants developed HNSCC. The expected number of incident HNSCC cases — according to SEER data — was 13.7.
Researchers determined the number of HNSCC cases in the lung screening study population was significantly higher than expected (standardized incidence ratio, 1.68; 95% CI, 1.06-2.52). This equated to an excess HNSCC burden in the study population of 28.9 cases per 100,000 person-years.
“Our study showed that head and neck cancer was more common among those targeted for lung cancer screening than in the general US population,” Diergaarde said. “These results suggest that it may indeed be beneficial to offer head and neck cancer screening to recommended lung cancer screenings.”
A reduction in mortality would have to be demonstrated before implementing such an approach, according to researcher David. O Wilson, MD, MPH, associate director of the University of Pittsburgh Medical Center Lung Cancer Center.
“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,” Wilson said in a press release. “If such screening reduces mortality in these at-risk patients, that would be a convenient way to increase early detection and save lives.”
Lung screening study participants diagnosed with HNSCC were more likely to be male (P=.003). They also were more likely to have been younger when they started smoking (mean age, 15.7 vs. 17.5), smoked more on a daily basis (P=.01) and had more smoking pack-years (mean, 71.7 vs. 51.5) than the rest of the study population.
“Randomized trials are needed to assess the benefits and harms — whether it truly reduces mortality and/or morbidity among those at high risk — of adding examination of the head and neck area to lung cancer screening programs,” Diergaarde said. “We are currently working with otolaryngologists to design a national trial that would determine this.” – by Alexandra Todak
Brenda Diergaarde, PhD, can be reached at University of Pittsburgh Cancer Institute, Research Pavilion, Suite 1.16, 5117 Centre Ave., Pittsburgh, PA 15213; email: mailto:diergaardeb@upmc.edu.
Disclosure: The researchers report no relevant financial disclosures.
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