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.