Effect of routine esophageal screening in patients with head and neck cancer.

IMPORTANCE Transnasal esophagoscopy or pandoscopy to conduct a tumor survey is routinely recommended for patients with head and neck squamous cell carcinoma (HNSCC). Despite this recommendation, the effect of routine esophageal screening remains unclear. OBJECTIVE To investigate the effect of routine esophageal screening on the detection of second primary esophageal squamous cell carcinoma (ESCC) among patients with HNSCC. DESIGN AND SETTING Retrospective study at the Academic Institute of Otolaryngology, Kaohsiung, Taiwan. PARTICIPANTS Medical records between January 1, 2004, and December 30, 2010, from 3053 patients with HNSCC were retrospectively reviewed. INTERVENTION Patients were divided into 2 groups based on whether or not they had received routine esophageal screening, and the 2 groups were compared. MAIN OUTCOME MEASURES Univariate logistic regression analysis was performed to investigate the odds ratios (ORs) for developing second primary ESCC at different sites. The prevalence and cancer stage of second primary ESCC among these 2 groups were compared using the χ2 test. RESULTS The prevalences and ORs of second primary ESCC at different tumor sites were 0.8% (reference) for the oral cavity, 6.2% (OR, 8.35) for the oropharynx, 6.6% (OR, 8.89) for the supraglottis, 8.3% (OR, 11.43) for the transglottis, and 14.2% (OR, 20.83) for the hypopharynx. The prevalence of second primary ESCC among the routine screening group (71 of 1592 [4.5%]) was significantly higher than that among the non-routine screening group (44 of 1461 [3.0%]) (P = .04). Among 115 second primary ESCC cases, patients in the routine screening group were diagnosed at an earlier cancer stage than patients in the non-routine screening group. CONCLUSIONS AND RELEVANCE Routine esophageal screening is recommended for patients with HNSCC, especially those with oropharyngeal, supraglottic, transglottic, and hypopharyngeal cancers. Routine esophageal screening can increase the early detection of second primary ESCC.