Individual head and neck screening: Initiating a dialogue about best approach

Kozak, Kyle J.; Achim, Virginie

doi:10.1016/j.amjoto.2021.103302

Cited by 4 publications

(8 citation statements)

References 23 publications

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Section: Epidemiological Background Of Oropharyngeal Hpv Infectionmentioning

confidence: 99%

“…Head and neck cancer, the sixth most common cancer worldwide, account for about 1 out of 20 malignant tumors [ 9 ]. Around two thirds of head and neck cancers are identified at late stages [ 9 ]. Squamous cell carcinomas occurring in the oral cavity, oropharynx, hypopharynx, and larynx mucosae constitutes over 90% of head and neck cancers [ 10 ].…”

Section: Epidemiological Background Of Oropharyngeal Hpv Infectionmentioning

confidence: 99%

“…The very long incubation period between oral infection and cancer development complicates strategies aimed at early diagnosis of HPV-related OPSCCs. More importantly, no specific precursor lesion has been consistently identified in the oral cavity and oropharynx [ 9 , 12 , 24 , 25 ]. Most HPV-related neoplasia originates in the epithelium lining the deepest portion of tonsillar crypts.…”

Section: Screening Early Diagnosis and Prevention Of Oropharyngeal Ca...mentioning

confidence: 99%

“…A dedicated follow-up program could be targeted toward specific high-risk subpopulations, e.g., men aged 50–65 years reporting previous multiple oral sexual partners or individuals with persistent oral HPV 16 infection [ 9 , 15 , 24 , 25 ]. However, no sufficient data is available to quantify the potential effect of such programs.…”

Section: Screening Early Diagnosis and Prevention Of Oropharyngeal Ca...mentioning

confidence: 99%

“…8 Otolaryngology -Head and Neck Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 9 • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year…”

Section: Abbreviationsmentioning

confidence: 99%

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A clinician’s dilemma: what should be communicated to women with oncogenic genital HPV and their partners regarding the risk of oral viral transmission?

et al. 2022

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Head and neck cancer, the sixth most common cancer worldwide, account for about 1 out of 20 malignant tumors. In recent years a reduction in the incidence of cervical cancer, but a concomitant major increase in the incidence of HPV-mediated oropharyngeal cancer caused by orogenital HPV transmission has been observed. Consequently, in wealthy countries oropharyngeal squamous-cell carcinomas (OPSCC) is now the most frequent HPV-related cancer, having overtaken cervical cancer. Without effective medical interventions, this incidence trend could continue for decades. As no specific precursor lesion has been consistently identified in the oral cavity and oropharynx, HPV vaccination is the logical intervention to successfully counteract also the rising incidence of OPSCCs. However, HPV vaccine uptake remains suboptimal, particularly in males, the population at higher risk of OPSCC. Alternative primary prevention measures, such as modifications in sexual behaviors, could be implemented based on knowledge of individual genital HPV status. Until recently, this information was not available at a population level, but the current gradual shift from cytology (Pap test) to primary HPV testing for cervical cancer screening is revealing the presence of oncogenic viral genotypes in millions of women. In the past, health authorities and professional organizations have not consistently recommended modifications in sexual behaviors to be adopted when a persistent high-risk HPV cervicovaginal infection was identified. However, given the above changing epidemiologic scenario and the recent availability of an immense amount of novel information on genital HPV infection, it is unclear whether patient counseling should change. The right of future partners to be informed of the risk could also be considered. However, any modification of the provided counseling should be based also on the actual likelihood of a beneficial effect on the incidence of HPV-associated oropharyngeal cancers. The risk is on one side to induce unjustified anxiety and provide ineffective instructions, on the other side to miss the opportunity to limit the spread of oral HPV infections. Thus, major health authorities and international gynecologic scientific societies should issue or update specific recommendations, also with the aim of preventing inconsistent health care professionals’ behaviors.

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Section: Epidemiological Background Of Oropharyngeal Hpv Infectionmentioning

confidence: 99%

Section: Epidemiological Background Of Oropharyngeal Hpv Infectionmentioning

confidence: 99%

Section: Screening Early Diagnosis and Prevention Of Oropharyngeal Ca...mentioning

confidence: 99%

Section: Screening Early Diagnosis and Prevention Of Oropharyngeal Ca...mentioning

confidence: 99%

Section: Abbreviationsmentioning

confidence: 99%

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A clinician’s dilemma: what should be communicated to women with oncogenic genital HPV and their partners regarding the risk of oral viral transmission?

et al. 2022

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Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Sykes,

Weisbrod,

Rival

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHead and neck cancers (HNCs) are often diagnosed at advanced clinical stages during their symptomatic phase, leading to a reduced treatment window and poor survival. Screening programs have been suggested as a mitigation strategy.ObjectiveTo examine the effectiveness of current HNC screening programs in improving diagnosis and survival in adults.Evidence ReviewThis Preferred Reporting Items for Systematic Reviews and Meta-analyses–guided systematic review involved use of peer-reviewed, English-language journal articles identified from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials between January 1, 2001, and July 15, 2022. Snowballing was applied to retrieve more studies. Eligible articles were original clinical trials and observational studies presenting a universal or risk-targeted screening program of primary HNC in the adult population. Reporting quality was assessed using the JBI’s critical appraisal tools.FindingsDatabase searches yielded 3646 unique citations with an additional 8 studies found via snowballing. Five reviewers assessed the full text of 106 studies. Sixteen articles were ultimately included in the review, involving 4.7 million adults (34.1%-100% male; median age, 30-59 years). Fifteen studies were based in Asia and 1 in Europe (Portugal). Five reported data from randomized clinical trials. An oral inspection conducted once or once every 2 to 3 years was described in 11 studies for screening oral cancer, while multistep screening involving Epstein-Barr virus serologic testing for nasopharyngeal carcinoma delivered every 1 to 4 years was presented in 5. In 4 trials and 6 observational studies, screening significantly increased the detection of localized (stage I/II) tumor or was associated with an increased proportion of diagnoses, respectively, regardless of the population and cancer subsites. Universal screening of asymptomatic adults improved 3- to 5-year overall survival but did not increase cancer-specific survival in 4 trials. Targeted screening improved overall and cancer-specific survival or was associated with improved survival outcomes in 2 trials and 2 observational studies, respectively. Studies had low to medium risks of bias.Conclusions and RelevanceEvidence from the existing literature suggests that a risk-targeted screening program for oral and nasopharyngeal cancers could improve diagnosis and patient survival. Screening adherence, societal cost-effectiveness, and optimal risk stratification of such a program warrant future research, especially in low-incidence settings outside Asia.

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Possibilities for the Early Diagnosis of Head and Neck Squamous Cell Carcinoma

Juster,

Page

2023

Cancer Screen Prev

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Head and neck cancers (including cancers of the oral cavity, oropharynx, hypopharynx, and larynx) are the sixth most common type of cancer worldwide. Almost all of these cancers are squamous cell carcinomas that develop from the mucosal lining. Due to the lack of specificity of the symptoms and inadequate screening methods, less than half of these tumors are currently discovered, albeit at an early stage. These cancers, therefore, constitute a real public health problem. Smoking, alcohol consumption, certain HPV infections, and chronic betel nut consumption are the main risk factors for developing squamous cell carcinoma of the upper aerodigestive tract. Early diagnosis depends on performing a complete and systematic physical examination of the oral cavity, pharynx, and larynx with a nasofibroscope in populations at risk. However, there are no strict criteria, in terms of alcohol and tobacco consumption, to trigger a physical examination by an ENT specialist, and there are no indications concerning the frequency with which such "screening" should be performed in at-risk populations. Even if such "screening strategies" are used in the absence of an alternative, different approaches are used in practice, depending on the medical system and country, and their efficacy and ideal modes of implementation remain unknown.

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Individual head and neck screening: Initiating a dialogue about best approach

Cited by 4 publications

References 23 publications

A clinician’s dilemma: what should be communicated to women with oncogenic genital HPV and their partners regarding the risk of oral viral transmission?

A clinician’s dilemma: what should be communicated to women with oncogenic genital HPV and their partners regarding the risk of oral viral transmission?

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Possibilities for the Early Diagnosis of Head and Neck Squamous Cell Carcinoma

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