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Research shows ways to catch throat cancer early

U-M beefs up outreach to uninsured, at-risk individuals to make free head and neck cancer screening clinics more effective

added 9/24/10

Ann Arbor - A good idea just got better, as the University of Michigan Health System this year improved how it attracts the people most at risk to its annual free head and neck cancer screening clinic.

A research study analyzing data from the U-M clinics held 1996 to 2009 showed that participants were at higher risk for suspicious lesions when the following risk factors were present: neck mass or oral pain, tobacco use, lack of health insurance, male gender, and separated marital status.

At this year's clinic April 17, organizers refined their usual recruitment strategy based on the study results.

"We reached out more personally and more broadly this year," says Norman D. Hogikyan, M.D., professor of otolaryngology at the U-M Medical School, who has directed the clinics since their inception 14 years ago and is the senior author of the research study.

Staff stepped up direct contacts with regional free health clinics and asked for help identifying at-risk patients. People with the risk factors got priority in scheduling screening appointments, too.

The study results will be presented at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Sept. 29 by first author and resident surgeon Andrew G. Shuman, M.D., of the U-M Department of Otolaryngology-Head and Neck Surgery. The study appears in the September issue of Otolaryngology-Head and Neck Surgery.

U-M medical personnel, clerical staff and others volunteer time for the clinics, held one Saturday each spring. The clinics are sponsored jointly by the U-M Department of Otolaryngology-Head and Neck Surgery and the U-M Comprehensive Cancer Center.

One clinic participant with some of the risk factors identified in the study is Larry Samples, 67, of Ypsilanti. A longtime smoker of cigars, he had developed hoarseness. He knew he was at risk for head and neck cancer.

"But I thought I had laryngitis," Samples says. As full-time caregiver for his mother, who has Alzheimer's, he has to repeat things constantly. Samples came to the U-M screening clinic in April, 2009 after hearing about it from his fiancée.

Based upon his examination, doctors at the screening asked Samples to come in for a follow-up visit. A suspicious lesion on his vocal cords turned out to be cancerous.

"The miracle of going to that clinic was, it was stage 1 and it had just started," Samples says. Within weeks, he underwent outpatient endoscopic laser surgery by Hogikyan and today remains cancer-free, going faithfully to follow-up exams at U-M.

Many people may fear going in for a screening, Samples says, but they should realize the painless exams are a not-to-be-missed opportunity. "If they have some of the risk factors, they need to go in and have things checked out."

Finding those at risk

In the past, clinic organizers reached the public through ads in buses, radio and newspapers, and flyers distributed to a number of local free health care centers. The clinic drew a wide mix of people, from the "worried well" to people who had symptoms and were pack-a-day smokers.

This spring, the Cancer Center's community outreach and Cancer AnswerLine™ staff not only mailed information about the clinic to caregivers at more than 60 free clinics in southeast Michigan, but also called and asked staff at the clinics to help identify and encourage high-risk patients to go to the screening.

"We asked the nurses scheduling appointments to ask about insurance status, tobacco use and symptoms, rather than allowing people to purely self-select for attending the screenings. Our goal was to get more of the higher-risk people in the door," Hogikyan says.

The new strategy may already have brought more at-risk people to the U-M clinic. The number of 2010 clinic participants who had suspicious lesions was more than double the average number seen annually during the years the study covered.

The study also found that more than half of the people who had a suspicious lesion did not return for the follow-up visit scheduled for them at U-M. Some may have gone to their own primary providers, while others may have chosen not to follow up to see if cancer was indeed present.

"Based upon the study results, we have taken an active rather than passive approach to follow-up this year," Hogikyan says, with phone calls and mailings not used before, and offers of transportation assistance for follow-up visits if needed.

Head and neck cancer statistics: 35,720 Americans will be diagnosed with head and neck cancers this year and 7,600 will die from this disease, according to the American Cancer Society.

Other U-M authors: Payam Entezami, Anna S. Chernin, Nancy E. Wallace, R.N., Jeremy M. G. Taylor, Ph.D.

Citation: Otolaryngology-Head and Neck Surgery, 2010;143(3):353-360

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Written by Anne Rueter; contact by phone: 734-764-2220 or email arueter@umich.edu

 


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