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Aetiology and risk factors for head and neck cancer: United Kingdom National Multidisciplinary Guidelines

  • R Shaw (a1) and N Beasley (a2)
Abstract
Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the aetiology and risk factors for head and neck cancer and the recommended interventions appropriate for each risk factor.

Recommendations

Recent evidence synthesis from National Institute for Health and Care Excellence suggests that the following brief interventions for smoking cessation work should be used:

Ask smokers how interested they are in quitting (R)

If they want to stop, refer them to an intensive support service such as National Health Service Stop Smoking Services (R)

If they are unwilling or unable to accept a referral, offer a stop smoking aid, e.g. pharmacotherapy. (R)

Brief interventions are effective for hazardous and harmful drinking. (R)

Specialist interventions are effective in people with alcohol dependence. (R)

Most people with alcohol dependence can undergo medically assisted withdrawal safely at home, after risk assessment. (R)

Management of leukoplakia is not informed by high-level evidence but consensus supports targeted use of biopsy and histopathological assessment. (R)

The management of biopsy proven dysplastic lesions favours:

advice to reduce known environmental carcinogens such as tobacco and alcohol (R)

surgical excision when the size of the lesions and the patient's function allows (R)

long-term surveillance. (R)

Fanconi anaemia patients should:

be followed up in a multidisciplinary specialist Fanconi anaemia clinic (G)

have quarterly screening for head and neck squamous cell carcinoma and an aggressive biopsy policy (G)

receive prophylactic vaccination against high risk human papilloma virus (G)

receive treatment for head and neck squamous cell carcinoma with surgery alone where possible. (G)

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Address for correspondence: Richard Shaw, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK. E-mail: Richard.shaw@liverpool.ac.uk
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1 DH Maasland , PA van den Brandt , B Kremer , RA Goldbohm , LJ Schouten . Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study. BMC Cancer 2014;14:187

2 JP Zevallos , MJ Mallen , CY Lam , M Karam-Hage , J Blalock , DW Wetter Complications of radiotherapy in laryngopharyngeal cancer: effects of a prospective smoking cessation program. Cancer 2009;115:4636–44

5 M Marron , P Boffetta , ZF Zhang , D Zaridze , V Wunsch-Filho , DM Winn Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. Int J Epidemiol 2010;39:182–96

7 ST Mayne , B Cartmel , V Kirsh , WJ Goodwin Jr. Alcohol and tobacco use prediagnosis and postdiagnosis, and survival in a cohort of patients with early stage cancers of the oral cavity, pharynx, and larynx. Cancer Epidemiol Biomarkers Prev 2009;18:3368–74

9 AJ Parker , EJ Marshall , DM Ball . Diagnosis and management of alcohol use disorders. BMJ 2008;336:496501

10 H Mehanna , T Beech , T Nicholson , I El-Hariry , C McConkey , V Paleri Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer – systematic review and meta-analysis of trends by time and region. Head Neck 2013;35:747–55

11 G D'Souza , AR Kreimer , R Viscidi , M Pawlita , C Fakhry , WM Koch Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007;356:1944–56

12 HM Mehanna , T Rattay , J Smith , CC McConkey . Treatment and follow-up of oral dysplasia – a systematic review and meta-analysis. Head Neck 2009;31:1600–9

13 MW Ho , EA Field , JK Field , JM Risk , BP Rajlawat , SN Rogers Outcomes of oral squamous cell carcinoma arising from oral epithelial dysplasia: rationale for monitoring premalignant oral lesions in a multidisciplinary clinic. Br J Oral Maxillofac Surg 2013;51:594–9

15 A Roosaar , L Yin , AL Johansson , G Sandborgh-Englund , O Nyren , T Axell . A long-term follow-up study on the natural course of oral leukoplakia in a Swedish population-based sample. J Oral Pathol Med 2007;36:7882

19 DI Kutler , VB Wreesmann , A Goberdhan , L Ben-Porat , J Satagopan , I Ngai Human papillomavirus DNA and p53 polymorphisms in squamous cell carcinomas from Fanconi anemia patients. J Natl Cancer Inst 2003;95:1718–21

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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