Incidence of Head and Neck Cancer With Lung Cancer Screening: Secondary Analysis of a Randomized Controlled Trial

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Abstract
Objectives/Hypothesis: To evaluate the incidence of head and neck cancers (HNC) in high‐risk current and/or former smokers with screening low‐dose computed tomography (LDCT) chest versus chest x‐ray (CXR).Study Design: Second analysis of randomized clinical trial.Methods: We performed a secondary analysis examining the incidence of HNC in the National Lung Screening Trial. This was a randomized trial comparing LDCT versus CXR screening for lung cancer detection in high‐risk individuals (30 pack‐year smokers who currently smoke or quit within the last 15 years, aged 55–74). We compared the incidence of HNC in participants screened with LDCT versus CXR. We performed subgroup analyses in participants with mucosal HNC (oral cavity, oropharynx, larynx, hypopharynx, nasal/sinus cavity, or nasopharynx) or nonmucosal HNC (thyroid or salivary gland) and examined survival in the two screening arms.Results: This trial enrolled 53,452 participants with a median follow‐up of 6.2 years after randomization. The incidence of HNC was 111.8 cases per 100,000 person‐years in the LDCT group versus 87.1 cases per 100,000 person‐years in the CXR group (rate ratio 1.30, 95% confidence interval [CI] 1.05–1.61). There were 11.7 deaths from HNC per 100,000 person‐years in the LDCT group and 12.9 deaths per 100,000 person‐years in the CXR group (hazard ratio 0.80, 95% CI 0.42–1.52).Conclusions: Participants screened with LDCT had a modestly higher incidence of HNC. As uptake and adherence of lung cancer screening guidelines improve, clinicians should recognize that incidental findings from screening may lead to increased detection of HNC.Level of Evidence: 3 Laryngoscope, 132:1609–1614, 2022

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