Comorbidity and early diagnosis of head and neck cancer in a medicare population

Background: This study assessed potential opportunities for an early diagnosis of head and neck cancers (HNCA), and the role played by comorbidity, among contacts by Medicare patients with the healthcare system before their diagnosis. Comorbidity was hypothesized to affect the relationship between use of healthcare services and stage of disease. Methods: The study database (n = 11,312) was constructed by linking files from the Surveillance, Epidemiology, and End Results Program 1991 through 1999 and those of the Center for Medicare and Medicaid Services Program. HNCA cases were comprised of the lip, oral cavity, pharynx, and larynx anatomic sites. Results: Among persons with no alcohol and tobacco-related comorbidities (ATC), increasing numbers of physician visits were independently associated with a reduced risk of advanced stage at diagnosis for all anatomic sites, but especially the pharynx and larynx. Among persons with one or more ATC, physician visits displayed no association with stage at diagnosis with the exception of laryngeal tumors, where physician visits were strongly associated with reduced risk of late stage at diagnosis. Over 46% of cases with advanced stage tumors, most of whom also had ATC disease, had greater than or equal to11 physician visits in the year preceding their diagnosis of HNCA. Conclusions: Potential opportunities for an earlier diagnosis of HNCA were found among the numerous contacts with the healthcare system that patients had prior to their cancer diagnosis. Such opportunities were especially numerous and relevant for persons with ATC and form the basis for combining high-risk with opportunistic screening approaches. (C) 2004 American journal of Preventive Medicine.