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Original Article |

A Comparison of Community-Based and Hospital-Based Head and Neck Cancer Screening Campaigns:  Identifying High-Risk Individuals and Early Disease

Michael S. Harris, MD; D. Ryan Phillips, MS; Julia L. Sayer, BSN, RN; Michael G. Moore, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):568-573. doi:10.1001/jamaoto.2013.3153.
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Importance An enduring challenge in the care of patients with head and neck cancer is identifying disease earlier. Appropriately designed screening campaigns are one proposed strategy.

Objective To determine whether a hospital-based or a community-based head and neck cancer (HNC) screening strategy is more effective in identifying high-risk individuals, signs and symptoms, and findings consistent with head and neck neoplasia.

Design, Setting, and Participants In this retrospective cohort analysis, data from HNC screening efforts held at a tertiary care medical center and at a local motorsports event were compared. Participants completed a questionnaire, and a focused physical examination was performed.

Main Outcomes and Measures Identification rates of high-risk individuals, signs and symptoms, and findings consistent with head and neck neoplasia.

Results The hospital-based and community-based efforts yielded 210 and 1380 individuals screened, respectively. The community-based screening events attracted a significantly greater proportion of participants with risk factors of HNC including male sex (P < .001), current tobacco use (P < .001), lifetime history of tobacco use (P = .03), smokeless tobacco use (P = .003), and current alcohol use (P = .04). The hospital-based screening events, however, attracted a statistically greater proportion of people reporting prior head and neck or otolaryngologic treatment (P < .001), history of cancer outside the head and neck (P < .001), and a greater median number of symptoms (P < .001) and examination findings (P < .001).

Conclusions and Relevance These data suggest that the 2 screening models attract 2 fundamentally different types of participants, and those in both groups may benefit from screening, albeit for different reasons: one has a higher rate of risk factors, and early-stage HNC might be discovered while it is more readily treatable; the other has a higher rate of concerning signs, symptoms, and findings, and screening might be used to diagnose or rule out HNC.

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Figure. Screening questionnaire form.

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