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Clinical Challenges in Otolaryngology
August 1998

Screening Patients With Head and Neck Cancer for Esophageal CancerA Lack of Adequate Data

Author Affiliations
 

KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD

Arch Otolaryngol Head Neck Surg. 1998;124(8):933. doi:10.1001/archotol.124.8.933

An implicit assumption underlying the efficacy of screening patients with head and neck cancer for esophageal carcinoma is that early detection will lead to a more favorable prognosis. As summarized by Agrawal and Wenig, esophagoscopy with or without mucosal iodine staining appears to have a greater sensitivity than esophagography in detecting early esophageal carcinomas. However, despite the compelling notion that survival will improve if a greater number of potentially curable esophageal carcinomas are detected, no study has yet examined whether patients with simultaneous tumors have an increased survival rate if the second tumor is detected with routine screening instead of later when it becomes symptomatic. Likely for this reason, the clinical practice guidelines published by the American Society for Head and Neck Surgery and the Society for Head and Neck Surgeons do not recommend routine esophageal screening, either with esophagoscopy or esophagography in asymptomatic patients. As shown in a recent population-based study of the use of esophagoscopy, most patients with head and neck cancer do not receive esophageal cancer screening as part of their initial examination.1 Moreover, there is substantial geographic variation in the use of esophageal screening (greater than a 4-fold difference) in the United States. This variation likely reflects underlying differences in professional opinion about the value of esophageal screening. Until new information can be obtained from more rigorously conducted clinical studies, there will remain uncertainty and disagreement about the efficacy and appropriate use of screening for asymptomatic esophageal tumors.

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