All over the country in May, hospitals are offering “Free Throat Cancer Screening.” A Google search turned up dozens of results for that specific term or the related “oral, head and neck cancer screening.”
Here’s one example, promoting “Oral, Head and Neck Cancer Awareness Week, May 8-14.”
This promotion uses ominous warnings:
Can you live without your voice?
What about your jaw?
Would you miss it if you couldn’t swallow food?
Throat cancer can take all of those things away, along with your ability to eat, talk and breathe normally. These debilitating problems can be prevented, but you have to catch cancer early.
Some promotions – such as this one – use celebrity pitches such as “If it happened to Michael Douglas, it can happen to you.”
Here’s one that states, “A 10-minute, painless screening could save your life.”
But where’s the evidence for that?
The Memorial Sloan-Kettering Cancer Center in New York states on its website:
Currently, there are no screening methods that have been proven to increase survival rates for head and neck squamous cell carcinomas. A screening physical examination of the neck, oropharynx (the middle section of the throat that includes the soft palate, the base of the tongue, and the tonsils), and the mouth has been widely adopted as part of a routine dental examination. However, there is no evidence that this intervention reduces mortality from oral cancer. It is likely that in the coming decades this routine screening will allow earlier identification of oral cancer, when it is in a less advanced form, but this has yet to be proven in clinical studies.
There are no head and neck squamous cell carcinoma screening guidelines from the American Cancer Society, the National Comprehensive Cancer Network (NCCN), or the National Cancer Institute. And, at present, there are no known tests of blood or saliva proven to be effective for detection of head and neck squamous cell carcinomas.
In an email, American Cancer Society chief medical officer Dr. Otis Brawley wrote:
“We do not have any screening guideline on head and neck cancer screening. I am less concerned about simple visual and physical examination than say blood tests or x-ray screening tests in other diseases.”
But if you look at some of the web promotions of these screenings, you’ll see that most never mention what KIND of screening would be done. I think that’s important information for people to know. Brawley continued:
“I do think patients should not be given some false reassurance that a regular screening examination for head and neck cancer is known to save lives. There is no study that I am aware of to support that.
Rather than opportunistic screening, I would prefer that we encourage a head and neck exam be done when people go to the dentist and that we teach and encourage internists and family practice doctors to do it during routine physical examinations. Many MD’s are not comfortable with mouth pathology but are comfortable with palpation about the neck and throat.
We desperately do need to stress that people who notice a neck or throat mass get it evaluated and those who have a sore throat for more than a few days get is checked. This frequently does not happen and people frequently present with 8-month histories of a sore throat or change in voice.”
That sounds like reasonable advice.
We think these screening promotions would be better if they addressed:
• exactly what was going to be screened (there’s a lot of anatomy in the combined oral-throat-head-neck region) and how;
• is there any evidence that such screening saves lives?
• are there any American Cancer Society or US Preventive Services Task Force guidelines on such screening? (You just read Brawley’s answer. The USPSTF states that “the evidence is insufficient to recommend for or against routinely screening adults for oral cancer.”)
Readers of this blog know that we often comment on apparently well-intentioned but misleading or incomplete public messages about various screening tests.
It’s interesting that in a recent survey of users of our site, screening issues came up just twice – out of hundreds of responses.
One wrote: “tiring of the almost complete focus on screening.”
The other wrote: “I find the posts on ‘pre-disease’ and disease screening extremely important. I wish more people would pay attention to the issue of screening programs with no evidence to support a reduction in mortality.”