Head & Neck Cancers: Screening Guidelines

The term “head and neck cancer” encompasses a wide range of tumors that occur in several areas of the head and neck region, including the nasal passages, sinuses, mouth, throat, larynx (voice box), swallowing passages, salivary glands, and the thyroid gland. The two major known risk factors for head and neck cancer are exposure to tobacco and heavy use of alcohol. A type of cancer of the head and neck known as head and neck squamous cell carcinoma (HNSCC) is a relatively uncommon disease, with 40,000 new cases and 10,000 deaths estimated in 2008 in the United States. Twenty-five percent of HNSCCs harbor human papillomavirus (HPV), a commonly occurring virus that may play a role in the development of head and neck cancer. Non-squamous cancers of the head and neck — which include tumors of the thyroid, skin adnexa, salivary glands, sarcomas, and lymphomas — are even more uncommon.

Head and Neck Cancer Risk – High-Risk Groups

Heavy exposure to tobacco and heavy use of alcohol are well documented as major risk factors for head and neck cancer. In addition, patients cured of HNSCC have an approximately 10 percent risk of developing second primary cancers of the head and neck at five years after treatment. Individuals with a premalignant lesion in the mouth known as dysplastic oral leukoplakia have an almost 30 percent risk of oral cancer at ten years after treatment. Individuals with the following diseases and syndromes are at increased risk for head and neck cancer: Fanconi anemia, a rare, inherited disease in which the bone marrow fails to function properly; Li-Fraumeni syndrome, a rare, inherited disorder that greatly increases the risk of developing several types of cancer; and Plummer-Vinson syndrome, a disorder characterized by long-term iron deficiency anemia, which causes swallowing difficulty.

Head and Neck Cancer Screening Tests

Currently, there are no screening methods that have been proven to increase survival rates for HNSCC. 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.

At Memorial Sloan Kettering Cancer Center, we offer yearly free head and neck screenings in the spring to anyone in the community. These screenings provide an opportunity to educate interested patients on awareness of oral cancer and its risk factors.

There are no HNSCC 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 HNSCC.

Our Head and Neck Screening Guidelines

Our doctors advise that all individuals have a yearly physical examination of the head and neck and oropharynx (the middle section of the throat that includes the soft palate, the base of the tongue, and the tonsils) conducted by their primary care physician, as well as a yearly routine dental evaluation to include examination of the neck and inspection of the oropharynx and the mouth.

Our Screening Guidelines for High-Risk Patients

For high-risk patients cured of HNSCC, our doctors use the NCCN's follow-up guidelines outlined below to look for both recurrence of the initial cancer and second primary cancer formation.

Physical exam

  • Year One: every one to three months
  • Year Two: every two to four months
  • Years Three to Five: every four to six months
  • Year Five and Beyond: every six to 12 months

Chest x-ray annually

If an individual has received radiation treatment of the thyroid, then a TSH thyroid function test should be performed annually.

For high-risk patients with surgically unremovable or recurrent dysplastic oral leukoplakia, our doctors recommend observation on the same schedule as above and biopsies for suspicious changes in the lesions. These patients are also sometimes eligible to be enrolled in prospective clinical trials in head and neck cancer prevention at Memorial Sloan Kettering.