Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg. 2023 Nov 1;149(11):1047-1056. doi: 10.1001/jamaoto.2023.3010.
Head and neck cancers (HNCs) are often diagnosed at advanced clinical stages during their symptomatic phase, leading to a reduced treatment window and poor survival. Screening programs have been suggested as a mitigation strategy.
To examine the effectiveness of current HNC screening programs in improving diagnosis and survival in adults.
This Preferred Reporting Items for Systematic Reviews and Meta-analyses-guided systematic review involved use of peer-reviewed, English-language journal articles identified from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials between January 1, 2001, and July 15, 2022. Snowballing was applied to retrieve more studies. Eligible articles were original clinical trials and observational studies presenting a universal or risk-targeted screening program of primary HNC in the adult population. Reporting quality was assessed using the JBI's critical appraisal tools.
Database searches yielded 3646 unique citations with an additional 8 studies found via snowballing. Five reviewers assessed the full text of 106 studies. Sixteen articles were ultimately included in the review, involving 4.7 million adults (34.1%-100% male; median age, 30-59 years). Fifteen studies were based in Asia and 1 in Europe (Portugal). Five reported data from randomized clinical trials. An oral inspection conducted once or once every 2 to 3 years was described in 11 studies for screening oral cancer, while multistep screening involving Epstein-Barr virus serologic testing for nasopharyngeal carcinoma delivered every 1 to 4 years was presented in 5. In 4 trials and 6 observational studies, screening significantly increased the detection of localized (stage I/II) tumor or was associated with an increased proportion of diagnoses, respectively, regardless of the population and cancer subsites. Universal screening of asymptomatic adults improved 3- to 5-year overall survival but did not increase cancer-specific survival in 4 trials. Targeted screening improved overall and cancer-specific survival or was associated with improved survival outcomes in 2 trials and 2 observational studies, respectively. Studies had low to medium risks of bias.
Evidence from the existing literature suggests that a risk-targeted screening program for oral and nasopharyngeal cancers could improve diagnosis and patient survival. Screening adherence, societal cost-effectiveness, and optimal risk stratification of such a program warrant future research, especially in low-incidence settings outside Asia.
头颈部癌症（HNC）在其有症状阶段经常被诊断为晚期临床阶段，导致治疗窗口缩小和生存机会降低。已经提出了筛查计划作为缓解策略。
研究当前的 HNC 筛查计划在改善成年人诊断和生存方面的效果。
本研究采用系统评价和荟萃分析的首选报告项目指导，使用同行评审的、英文期刊文章，这些文章是从 MEDLINE、Embase 和 Cochrane 对照试验中心数据库中检索到的，检索时间从 2001 年 1 月 1 日至 2022 年 7 月 15 日。滚雪球法被用于检索更多的研究。合格的文章是原始的临床试验和观察性研究，这些研究在成年人群中提出了原发性 HNC 的普遍或风险靶向筛查计划。使用 JBI 的批判性评估工具评估报告质量。
数据库搜索产生了 3646 个独特的引文，通过滚雪球法又找到了 8 项研究。五名评审员评估了 106 项研究的全文。最终有 16 篇文章被纳入综述，涉及 470 万成年人（34.1%-100%为男性；中位年龄为 30-59 岁）。15 项研究基于亚洲，1 项研究基于欧洲（葡萄牙）。五项报告了随机临床试验的数据。11 项研究描述了每 1 到 3 年进行一次或一次口腔检查以筛查口腔癌，而 5 项研究则介绍了每 1 到 4 年进行一次涉及 Epstein-Barr 病毒血清学检测的鼻咽癌多步骤筛查。在 4 项试验和 6 项观察性研究中，筛查分别显著增加了局部（I/II 期）肿瘤的检出率，或与诊断比例的增加相关，无论人群和癌症亚部位如何。对无症状成年人进行的普遍筛查提高了 3 至 5 年的总生存率，但在 4 项试验中并没有提高癌症特异性生存率。针对特定人群的筛查提高了整体和癌症特异性生存率，或与 2 项试验和 2 项观察性研究中的生存结果改善相关。这些研究的偏倚风险较低或中等。
现有文献的证据表明，针对口腔和鼻咽癌的风险靶向筛查计划可以改善诊断和患者生存。筛查的依从性、社会成本效益以及此类计划的最佳风险分层需要进一步研究，特别是在亚洲以外发病率较低的地区。
