RESULTS:
Over a 14 month period, 510 patients completed the survey and fulfilled
inclusion/exclusion criteria. The majority of patients (86.5%) had no
history of head and neck cancer (Table 1). The most common reason for
clinic visit was an ear primary complaint (N=292, 57.43% of total
patients) as seen in Table 2. This was followed by voice issue (N=176,
34.5%) and non-cancerous mouth/throat issue (N=139, 27.3%). Patients
responded with multiple primary complaints and as such the total N in
Table 2 is 830, however, percentages were calculated based on total
number of patients (510).
Our primary outcome was to assess the baseline awareness of head and
neck cancer (HNC) risk factors among the general otolaryngology patient
population. The most well recognized risk factors were smoking
cigarettes and chewing tobacco with 83.7% and 77.5% of patients with
correct survey answers, respectively (Table 3). Only 29.0% of patients
identified alcohol as a risk factor for HNC. Patients had little
knowledge of the other positive risk factors: not brushing teeth
(26.3%), oral sex (21.8%), betel quid (14.5%), and mouthwash (6.1%).
The survey contained additional factors that have not been proven to be
a positive risk factor for head and neck cancer in the most recent
literature. These factors, i.e. non-risk factors, included microwaved
plastic, smoking marijuana, artificial sweeteners, kissing, cocaine,
heroin, methamphetamines, spicy foods, salty foods, e-cigarettes, and
eating marijuana. The majority of patients correctly identified these
non-risk factors as not contributing to HNC. However, 42.5% of patients
believed e-cigarettes have a carcinogenic effect in HNC.
Our secondary goal in this study was to assess the difference in risk
factor knowledge between patients with a history of HNC and those
without. There were 69 patients with a history of HNC that completed the
survey. Of HNC patients, 40.6% of patients identified alcohol as a risk
factor compared to 27.2% of non-HNC patients (Table 3). HNC patients
more frequently identified oral sex as a risk factor for head and neck
cancer (33.3% vs 20.0%). Drugs with no causative link to HNC including
heroin, methamphetamines, and cocaine were more often correctly
identified as non-carcinogenic factors by cancer patients (Table 3).
However, non-cancer patients more often correctly reported chewing
tobacco as a risk factor (78.9%) compared to 68.1% of HNC patients.
The remainder of the risk factors did not show a statistically
significant difference in answers between cancer and non-cancer
patients.