Fewer Head and Neck Cancer Diagnoses During COVID May Mean Trouble Ahead
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Fewer Americans were newly diagnosed with early-stage head and neck cancer in 2020, a decline of 8 percent from 2019, according to a new study published in the Journal of the American Medical Association. But that’s not necessarily good news. Researchers theorized that the drop in diagnoses was due to fewer people accessing healthcare in the fraught and confusing early months of the COVID-19 pandemic because of fear of contracting the virus in healthcare settings. The result may be a future wave of later, more advanced-stage head and neck cancers that could have been caught earlier, according to the study’s senior author, Nosayaba Osazuwa-Peters, PhD, associate professor in head and neck surgery at Duke University in Durham, North Carolina.
“With COVID, we saw a decrease in early-stage diagnoses, which was already a problem,” Dr. Osazuwa-Peters says. “Prior to COVID, only a third of head and neck cancer patients would present with localized disease, meaning the cancer had not spread, and the rest were diagnosed at a later stage.”
“We expect that in subsequent years, we will see more people present with more advanced head and neck cancer because of the [missed opportunities for] early diagnosis in 2020,” he says. That could be a problem for patients because head and neck cancer, like most cancers, is more challenging to treat when it has spread to other areas of the body.
“We always want to catch the disease earlier,” Osazuwa-Peters says. “For head and neck cancer, early-stage treatment might require only surgery if the cancer is localized. Surgery is [already] difficult, but when you add chemotherapy and other treatments, which you do at later stages, patients are sicker and have longer recovery times.”
The five-year survival rate for head and neck cancer can be up to 90 percent, per the Cleveland Clinic, meaning up to 90 percent of people will be alive after five years, if diagnosed early. This rate drops significantly for people diagnosed with metastatic head and neck cancer, meaning that the cancer has spread to a distant site.
Know the Risk Factors and Symptoms for an Early Diagnosis
The biggest risk factors for head and neck cancer are tobacco use, alcohol use, and human papilloma virus (HPV) infection. Although symptoms of head and neck cancer — chronic sore throat, a lump in the neck, or voice changes, to name a few — could be caused by many other things, it’s important to get them checked out for the possibility of cancer. A dentist should also be consulted about any issues with your mouth, even if they don’t involve the teeth.
There is currently no routine head and neck cancer screening for someone without symptoms. Your primary care doctor may check your neck for lumps during an annual physical, and your dentist may tell you if there is something out of the ordinary in your mouth. Because HPV is one risk factor for head and neck cancer, vaccination is recommended for people between 11 and 26 years, notes the Centers for Disease Control and Prevention. But generally, the burden is on you to check for signs of head and neck cancer, then notify a doctor if anything seems out of the ordinary.
Osazuwa-Peters noted a “spousal effect” where one partner notices something peculiar on their partner and suggests getting an exam. “It could be a spouse encouraging a partner to check out why they sound hoarse. Or, ‘Honey, I think you should get this lump looked at.’ During COVID, that might have happened less,” he says.
Future Studies
This study is significant for its scope. It was a population-level assessment, meaning that it’s far broader than a typical data set of one or two hospital systems. Researchers used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program population registry to better reflect the overall US population and the possible impact of COVID-19 on cancer screening.
“To our knowledge, this is the first population-based analysis of head and neck cancer diagnoses during COVID [that] accounts for its impact,” Osazuwa-Peters says. “We don’t know about 2021 or 2022 yet, but because COVID has been such a watershed event we assume there will be some effect in those years.”
Osazuwa-Peters notes that SEER data for 2021 will be available in a few months, which his team plans to analyze to determine any continued impacts of the pandemic on head and neck cancer diagnoses.
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