Public awareness of head and neck cancer is limited, with the lack of awareness including the term head and neck cancer and common symptoms and risk factors, such as tobacco use and human papillomavirus (HPV), according to results of a cross-sectional online survey reported in JAMA Otolaryngology-Head & Neck Surgery. This lack of awareness “is concerning given the importance of risk factor avoidance and modification, as well as early patient detection, as drivers of prevention and improved outcomes,” the study authors commented.
The online survey of 2,126 randomly selected adults in the United States was conducted in early January 2013. The mean age of those responding was 42 years (range, 15.2–18.92 years), and 30.2% identified as current or former smokers. Only 3.6% reported having more than four drinks per day. Most respondents identified as white (78.5%), and a slightly higher percentage were women (54.8%). The south was represented by a higher percentage of respondents (30.1%) than the midwest, northeast, and west.
“Self-reported respondent knowledge of [head and neck cancer] was low, with 66.0% reporting that they were ‘not very’ or ‘not at all’ knowledgeable. This did not vary significantly with tobacco use (P = .92), education (P = .053), sex (P = .07), or race (P = .02),” the investigators stated. Most respondents lacked understanding of the organs or tissues affected by head and neck cancer, with 21% incorrectly identifying brain cancer as head and neck cancer. Among those correctly identifying head and neck cancer sites, 22.1% of respondents correctly identified throat cancer, 15.3% mouth cancer, and 2.0% cancer of the larynx.
“Questions about symptoms of [head and neck cancer] revealed that almost all respondents lacked knowledge of common symptoms, with only 14.9% identifying ‘red or white sores that do not heal’ and even fewer identifying other important symptoms such as ‘sore throat’ (5.2%), ‘bleeding in the mouth or throat’ (0.5%), or ‘swelling or lump in the throat’ (1.3%),” the researchers reported. “Headache, a nonspecific symptom that is uncommon in [head and neck cancer], was the symptom most frequently identified as a symptom of [head and neck cancer] among survey participants (19.0%).”
Role of HPV
Smoking was identified as a risk factor by 54.5%, chewing or spitting tobacco by 32.7%, alcohol use by 4.8%, and prolonged sun exposure by 0.6%. “Only 0.8% of respondents identified HPV infection as a risk factor for mouth and throat cancer, but specific questioning revealed that 12.8% were aware of the association between HPV infection and throat cancer, whereas 70.0% of respondents were aware of the vaccine targeting HPV,” the researchers reported. “The lack of awareness of the association between HPV infection and throat cancer and the greater awareness of the vaccine among women suggest that this knowledge is primarily due to awareness of the role of HPV in uterine cervical cancer,” the authors added.
The researchers estimated that widespread HPV vaccination could prevent almost 9,000 cases of oropharyngeal cancer annually. “However, greater awareness of the role of HPV infection in oropharyngeal cancer is necessary to improve vaccine adherence, especially in men,” the authors noted. “In addition, greater awareness of the disease may prompt patients harboring symptoms of HPV-positive cancers to seek evaluation while also prompting dentists and physicians to consider this in the differential diagnosis of more common diseases such as pharyngitis, tonsillitis, and benign lymphadenopathy.”
The authors noted that 5-year survival rates have improved only modestly, and the proportion of patients diagnosed in late stages of disease has remained essentially constant. “Given that routine screening for [head and neck cancer] by primary care physicians is rarely performed and currently not recommended by the U.S. Preventive Services Task Force, early detection depends on patient recognition. Similarly, primary prevention of [head and neck cancer] largely depends on awareness and avoidance of environmental risk factors. Public awareness of [head and neck cancer] is therefore necessary for both primary and secondary prevention.” ■
Luryi AL, et al: JAMA Otolaryngol Head Neck Surg. June 5, 2014 (early release online).