American Association of Oral and Maxillofacial Surgeons

Position Paper

Head and Neck Cancer Screening and Prevention
Background
Worldwide, approximately 650,000 new patientsare diagnosed with head and neck cancers annually –resulting in more than 330,000 deaths each year. Morethan 90 percent of head and neck cancers (excluding skincancers) arise from the mucosal layers of the oral cavity,oropharynx and larynx.1 Oral and oropharyngeal cancer
accounts for 1.6 percent of all cancer deaths in the UnitedStates.2

Risk Factors
Major risk factors for oral and oropharyngeal cancerinclude tobacco use, alcohol consumption, the synergistic
interaction of tobacco use and alcohol consumption, betel
quid (“paan”) chewing, infection with certain strains of
the human papillomavirus, and a previous history of oral
and oropharyngeal cancer.2,3,4,5,6 Individuals with rare
inheritable diseases and other disorders – such as Fanconi
anemia, Li-Fraumeni syndrome, dyskeratosis congenita,
Bloom syndrome, Plummer-Vinson syndrome andacquired immunodeficiency – also are at increased
risk for developing head and neck cancer.2, 4, 5, 7

Screening
The five-year relative survival rate after being diagnosed
with oral or oropharyngeal cancer is approximately
65.3 percent. Improved survival rates are seen at earlier
stages of diagnosis – 84.4 percent for localized disease,
66 percent for regional lymph node metastasis and 39.1
percent for distant metastasis. Unfortunately, 67 percent
of all new cases of oral and oropharyngeal cancers
are diagnosed at a late stage (having regional and/ordistant spread).8 A delay in the diagnosis of oral cancer
has been shown to increase the risk for advanced stageand mortality, highlighting the importance of early
identification and diagnosis.9
Currently, there is a lack of evidence to either support
or refute the benefit and cost-effectiveness of screening
the general population for head and neck cancer. However,there is evidence that a visual examination as part of an
PAGE 1 Head and Neck Cancer Screening and Prevention

opportunistic screening – or screening as part of a periodic
health examination – has been effective in reducing themortality rate of oral cancer in high-risk individuals
who use tobacco and/or alcohol.10,11,12 Adjunctive
technologies – such as toluidine blue, cytologic testing,
autofluorescence, tissue reflectance and salivary adjuncts –have demonstrated limited diagnostic accuracy to routinely
be used as screening tools for head and neck cancer.12, 13
Based on the current evidence available, the American
Association of Oral and Maxillofacial Surgeons (AAOMS)
recommends healthcare providers conduct a history withrisk assessment of patients regularly and perform a visualand tactile exam of the head and neck in patients identified
as having risk factors and/or signs and symptoms for oraland oropharyngeal cancer. For dental providers, it isrecommended that a thorough head and neck exam be
performed at each dental visit.
For patients who have already been treated for headand neck cancer, AAOMS supports the follow-up
recommendations outlined by the National Comprehensive
Cancer Network (NCCN) to evaluate for both recurrenceof the initial cancer and development of a second primarycancer.
The NCCN follow-up recommendations for head and neckcancers include:• Year 1: every one to three months• Year 2: every two to six months• Years 3 to 5: every four to eight months• Beyond 5 years: every 12 months
Patients who have a surgically unexcisable or recurrent
dysplastic oral lesion should also be followed. Biopsies
may be performed as needed for suspicious changes inthese lesions.
The recommended history risk assessment witha visual and tactile head and neck exam should follow
the protocol described by the National Institute of Dental
and Craniofacial Research (NIDCR) and the World HealthOrganization (WHO).

Any suspicious lesions or masses (e.g., leukoplakia,
erythroleukoplakia, erythroplakia, ulcerated lesions, oral
submucous fibrosis) should be evaluated and considered
for biopsy for a definitive diagnosis or referred to a
specialist for evaluation and monitoring.

References:
1. Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer Statistics
2018: GLOBOCAN estimates of incidence and mortality worldwide
for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer
J. Clin 2018; 68(1): 7-30.
3. Dhull A, Atri R, et al. Major risk factors in head and neck cancer:
A retrospective analysis of 12-year experiences. World J Oncol. 2018
Jun; 9(3): 80-84.
4. Shaw R, Beasley N. Aetiology and risk factors for head and neckcancer: United Kingdom National Multidisciplinary Guidelines. J
Laryngol Otol. 2016; 130: S9-S12.
5. Chi AC, Day TA, Neville BW. Oral cavity and oropharyngeal
squamous cell carcinoma – an update. CA Cancer J Clin 2015;
65(5): 401-421.
6. Duncan LD, Winkler M, Carlson ER et al: p16
Immunohistochemistry Can Be Used to Detect Human
Papillomavirus in Oral Cavity Squamous Cell Carcinoma. J Oral
Maxillofac Surg 71: 1367-1375, 2013.

Position Paper
7. Patel SC, Carpenter WR, Tyree S, et al. Increasing incidence of oral
tongue squamous cell carcinoma in young white women, age 18 to44 years. J Clin Oncol 2011; 29(11): 1488-1494.
8. National Cancer Institute. Surveillance, Epidemiology, and End
Results Program. Cancer Stat Facts: Oral Cavity and Pharynx
Cancer 2019 (Based on SEER 18 2009-2015). Available at
SEER.Cancer.gov/statfacts/html/oralcav.html
9. Seoane J, Alvarez-Novoa P, Gomez I, et al. Early oral cancer
diagnosis: The Aarhus statement perspective. A systematic review
and meta-analysis. Head Neck 2016 38: E2182-2189.
10. American Dental Association. Current Policies adopted 1954-2016:
Early Detection and Prevention of Oral Cancer (Trans.2014:506), p.
180, 2017.
11. Opportunistic oral cancer screening: a management strategy fordental practice. BDA Occasional Paper 6: 1-36, 2000.
12. Brocklehurst P, Kujan O, O’Malley L, et al. Screening programmes
for the early detection and prevention of oral cancer. Cochrane
Database of Systematic Reviews 11: CD004150.
13. Lingen M, Abt E, Agrawal N, et al. Evidence-based clinical practiceguideline for the evaluation of potentially malignant disorders in
the oral cavity. A report of the American Dental Association. JADA
2017:148(10): 712-727.

© 2020 American Association of Oral and Maxillofacial Surgeons.
No portion of this publication may be used or reproduced without
the express written consent of the American Association of Oral andMaxillofacial Surgeons.

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