Are You At Risk for Head and Neck Cancer?
Head and neck cancers are often disfiguring and sometimes deadly. In 2009, there were an estimated 35,720 new cases of head and neck squamous cell carcinoma (HNSCC) and approximately 7,600 deaths. Developing a molecular fingerprint for head and neck cancer tumors could help improve diagnosis and treatment for these cancers.
This study takes a big step toward that goal by identifying five risk factors for late-stage head and neck cancer – two genes, tumor grade, vascular invasion and location of the tumor.
"We were able to look at the many intertwined variables influencing health and disease to understand the contribution of tumor genetic alterations, pathologic, and patient factors in head and neck cancer diagnosis and outcomes," lead author, Maria J. Worsham, Ph.D., director of research in the Department of Otolaryngology at Henry Ford Hospital was quoted as saying.
"We then used comprehensive modeling that accounted for the different variables, which no other study has done. By taking into account so many different factors, we were able to look at what rises to the top as a predictor for late-stage disease,” Dr. Worsham explained.
In an effort to learn more about what factors influence HNSCC stage and survival, Dr. Worsham and her colleagues went beyond looking at patient demographic and tumor pathology factors, like so many previous studies have done. Instead, they had a very diverse patient population to better understand how a wide array of risk factors interacts with disease stage, diagnosis and survival.
The study looked 689 Henry Ford patients from 1986 to 2005 with a primary diagnosis of HNSCC. Most notably, 42 percent of the study group was African American. It examined 23 non-genetic patient risk factors including race, martial status and family history, and also looked at patients' tumor biology by examining tumor DNA for 113 genes from 2,166 tissue blocks. All of these factors were placed into statistical models to determine both individual and commingling independent variables that influence late-stage disease.
Previous studies have suggested African Americans are more likely to have late-stage disease with worse survival, the Henry Ford multivariate analysis found that race is not a risk factor for late-stage HNSCC for two reasons: Unlike previous studies, their study included a large African American population and of those patients, 88 percent had some form of insurance.
"A large proportion of our study group, both African American and Caucasian, had insurance," notes Dr. Worsham. "This finding really shows the impact of insurance and access to care on overall patient care. Removing barriers does make a difference."
The study also found that the site of the tumor in head and neck cancer had an impact on disease stage. Patients with cancer in the oropharynx, which lies behind the oral cavity, and those with cancer in the hypopharynx, located at the bottom part of the pharynx, are more likely to have late-stage disease.
"Ultimately, the more clues we have about what influences head and neck cancer diagnosis and survival, the more we can put toward understanding how to treat patients and counteracting its effects through designing special drugs," says Dr. Worsham.
SOURCE: American Head and Neck Society 2010 Research Workshop in Arlington, VA., held October 28, 2010