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Patel EA, Shah SV, Poulson TA, Jagasia AA. An Integrative Model of ENT Healthcare for the Homeless Population. Laryngoscope 2024; 134:2705-2709. [PMID: 38362639 DOI: 10.1002/lary.31332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/29/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Our aim was to determine the need for otolaryngology care within the homeless population, identify barriers to access that the homeless population may face, and develop a model system which would address these needs with respect to the barriers. METHODS A retrospective chart review of 812 patients seen between 1/25/16-3/21/2020 was performed. Charts were obtained from homeless patients seen at free general clinics held shelters in Chicago, IL (781 charts) and in Champaign, IL (31 charts). Records reporting at least one otolaryngology disease in a patient experiencing homelessness were included in this study. Patients were considered homeless if they resided at the shelter at the time of their appointment. To determine common barriers to care, a simple yes/no questionnaire was administered to residents at west-side Chicago homeless shelters. Questions addressed barriers to health care access that had been mentioned by patients seen at free clinics. RESULTS Chart review findings demonstrated that 14.3% (n = 142) of all homeless patients seen at free in-shelter clinics were seen for ENT-related disorders. Survey results revealed that 76.3% (n = 71) of respondents believed that telemedicine services would be useful in shelters. 74.2% (n = 69) stated they were unable to afford prescribed medications. 93.5% (n = 87) stated that better access to transportation would increase their likelihood of seeking care. CONCLUSIONS In our attempt to bridge this inequity, we have launched a hybrid in-person/virtual care program to improve access to otolaryngology care for the homeless community. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2705-2709, 2024.
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Affiliation(s)
- Evan A Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Swapnil V Shah
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Creighton University School of Medicine, Omaha, Nebraska, U.S.A
| | - Trevor A Poulson
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ashok A Jagasia
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Mavedatnia D, Hathi K, Feschuk AM, Grose EM, Eskander A. Individuals Experiencing Homelessness: A Systematic Review of Otolaryngology-Related Health Needs and Community-Based Interventions. Otolaryngol Head Neck Surg 2023; 168:1301-1311. [PMID: 36939409 DOI: 10.1002/ohn.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Access to and use of physician services is limited for those experiencing homelessness. Homelessness may predispose patients to several Otolaryngology-Head and Neck Surgery (OHNS) health conditions and barriers to care may leave these unaddressed. The aim of this review was to synthesize the literature on OHNS health needs and community-based interventions for patients experiencing homelessness. DATA SOURCES English literature was searched in MEDLINE, EMBASE, and CINAHL. REVIEW METHODS Studies were included if they reported on OHNS-related conditions in patients experiencing homelessness and/or interventions related to providing OHNS care to this patient population. RESULTS Twelve hundred and one articles were screened, and 12 articles were included. Most studies reported on otologic conditions (n = 8) and head and neck-related conditions (n = 6). Nasal trauma, chronic rhinosinusitis, dysphonia, hearing loss, and cancerous/precancerous head and neck lesions were common OHNS conditions reported in this patient population. Identified barriers to care included lack of transportation, financial considerations, and lower health literacy. Three articles on community-based interventions were included. Most of these interventions were single visits to shelters, and ensuring adequate follow-up was identified as a challenge. CONCLUSION The current literature brings attention to certain OHNS diseases that are prevalent in this unique patient population and identifies unique barriers these patients experience when accessing care. Future studies should focus on further delineating the impact of OHNS diseases in patients experiencing homelessness and screening interventions that can be employed to mitigate the impact of diseases of the head and neck.
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Affiliation(s)
- Dorsa Mavedatnia
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kalpesh Hathi
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Aileen M Feschuk
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Elysia M Grose
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Toronto, Canada
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Kozak KJ, Achim VD. Individual head and neck screening: Initiating a dialogue about best approach. Am J Otolaryngol 2022; 43:103302. [PMID: 34894446 DOI: 10.1016/j.amjoto.2021.103302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/28/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE We aim to investigate the true benefits of free individual HNC screening in a high-risk urban population as well as the associated risks. MATERIALS AND METHODS This is a retrospective descriptive study. Free HNC screening was performed from 2014 to 2019. Participants were issued a questionnaire at the time of screening. After exemption by the Institutional Review Board, completed screening questionnaires were entered into a database and descriptive statistics were generated. The primary outcome measure for this study was the detection rate for HNC. We hypothesized that screening would be low yield based on previous studies (Gogarty et al., 2016). RESULTS This was a volunteer sample with a total of 410 participants, and the highest yield screening year was 2019 (n = 187). For all years, the cancer detection rate was 0%. In 2019, 134 (77.9%) of participants did not recognize the early symptoms of HNC, and 120 (73.2%) reported the screening program increased their awareness of the disease. 13 (7.6%) reported HPV vaccination while 126 (71.2%) were unaware that HPV has been linked with head and neck cancer. CONCLUSIONS HNC screening is an excellent opportunity for education regarding HNC risk factors. However, it is not a cost-effective use of physician time, does not increase detection rates even in high-risk segments of the general population, and is not completely without risk in the context of COVID-19. Perhaps the focus of HNC screening should shift from individualized screening to education and health promotion.
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Ralli M, Marinelli A, De-Giorgio F, Crescenzi D, Vincentiis MD, Greco A, Arcangeli A, Ercoli L. Prevalence of Otolaryngology Diseases in an Urban Homeless Population. Otolaryngol Head Neck Surg 2021; 166:1022-1027. [PMID: 34813392 DOI: 10.1177/01945998211060699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Otolaryngology diseases are common among people experiencing homelessness; however, they are seldom evaluated in a specialist setting, and investigations on their prevalence have rarely been conducted. The aim of this retrospective study was to evaluate the prevalence of otolaryngology conditions in an urban homeless population. STUDY DESIGN Retrospective study. SETTING Primary health care facility. METHODS The clinical records of patients referred to the medical facilities of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, between October 1, 2019, and July 31, 2021, were retrospectively reviewed; those reporting at least 1 otolaryngology disease were included in the study. RESULTS A total of 2516 records were retrospectively reviewed, and 484 (19.24%) were included in the study. The most common otolaryngology disease was pharyngotonsillitis (n = 118, 24.13%), followed by rhinitis with nasal obstruction (n = 107, 21.88%), hearing loss (n = 93, 19.01%), otitis (n = 81, 16.56%), abscess (n = 46, 9.40%), and sinusitis (n = 33, 6.74%). Head and neck cancer or precancerous lesions were reported in 34 subjects (7.02%). More than 1 simultaneous otolaryngology disorder was found in nearly 50% of our sample. A wide range of comorbidities was also reported. CONCLUSIONS Our results confirm an elevated otolaryngology demand in the homeless population and encourage the development of more efficient and effective strategies for a population-tailored diagnosis and treatment of these conditions.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy.,Primary Care Services, Eleemosynaria Apostolica, Vatican City State
| | - Alessia Marinelli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Arcangeli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Ercoli
- Primary Care Services, Eleemosynaria Apostolica, Vatican City State.,Istituto di Medicina Solidale Onlus, Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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Marino MJ, Hsieh MC, Wu EL, Riley CA, Wu XC, McCoul ED. Early Versus Late Computed Tomography and Nasal Endoscopy in the Diagnosis of Nasopharyngeal and Paranasal Sinus Malignancy. Am J Rhinol Allergy 2019; 33:388-394. [PMID: 30900468 DOI: 10.1177/1945892419838106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) may be associated with an increased risk of subsequent diagnosis of nasopharyngeal carcinoma (NPC) or paranasal sinus cancer (PSC) in elderly Americans. The clinical utility of this association remains uncertain. Objective To compare early computed tomography (CT) or nasal endoscopy (NE) with late diagnostic studies for the diagnosis of NPC or PSC in elderly Americans with CRS or AR. Methods The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was queried from 2003 to 2011 and included 150 088 Medicare beneficiaries. Patients with a diagnosis of CRS or AR were examined for either NE or CT performed within 6 months of the exposure diagnosis. The risk of a cancer diagnosis was determined between the early and the late diagnostic groups. Results The relative risk of early cancer diagnosis with NE was 1.98 (95% confidence interval [CI], 1.60–2.43). The number needed to detect (NND) a case of cancer with NE was 503 (95% CI, 387–718). The relative risk of an early cancer diagnosis using CT was 3.40 (95% CI, 2.85–4.06) and NND was 221 (95% CI, 194–255). The stage of NPC or PSC for the late diagnostic group was not different from those with early NE ( P = .458) or CT ( P = .497). Overall survival was not different between diagnostic groups for NE ( P = .789) or CT ( P = .425). Conclusions Early NE or CT is associated with a higher likelihood of cancer diagnosis in elderly individuals with a diagnosis of CRS or AR. The clinical utility of this association is limited due to the low prevalence of these malignancies and lack of difference in disease stage and overall survival between diagnostic groups.
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Affiliation(s)
- Michael J Marino
- 1 Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | - Mei-Chin Hsieh
- 2 Louisiana Tumor Registry, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Eric L Wu
- 3 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles A Riley
- 4 Division of Otolaryngology, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Xiao-Cheng Wu
- 2 Louisiana Tumor Registry, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Edward D McCoul
- 3 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,5 Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,6 Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana
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Riley CA, Marino MJ, Hsieh MC, Wu EL, Wu XC, McCoul ED. Detection of laryngeal carcinoma in the U.S. elderly population with gastroesophageal reflux disease. Head Neck 2019; 41:1434-1440. [PMID: 30681216 DOI: 10.1002/hed.25600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An association is suggested between gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) and malignancy of the larynx in elderly patients in the United States. Early detection with flexible fiberoptic laryngoscopy (FFL) or CT remains poorly defined. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was queried from 2003 to 2011.A case-cohort design evaluated patients aged 66 and older with a diagnosis of GERD and/or LPR for the occurrence of FFL or CT within 6 months of the exposure diagnosis. RESULTS Of a total 156 426 Medicare beneficiaries, the relative risk of early cancer diagnosis with FFL was 14.61(95% confidence interval [CI], 13.59-15.70), corresponding to a number needed to detect (NND) a case of cancer of 13(95% CI, 13-14). The relative risk of an early cancer diagnosis with CT was 31.83 (95% CI, 29.57-34.26), with a NND of 5 (95% CI, 5-5). CONCLUSIONS Early FFL and CT are associated with a higher likelihood of laryngeal cancer diagnosis in elderly individuals with a diagnosis of reflux. Screening trials are necessary to establish this relationship.
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Affiliation(s)
- Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical Center, New York, New York
| | - Michael J Marino
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Foundation, Phoenix, Arizona
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Eric L Wu
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana
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Characteristics and predictors of oral cancer knowledge in a predominantly African American community. PLoS One 2017; 12:e0177787. [PMID: 28545057 PMCID: PMC5435300 DOI: 10.1371/journal.pone.0177787] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/03/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose To characterize smoking and alcohol use, and to describe predictors of oral cancer knowledge among a predominantly African-American population. Methods A cross-sectional study was conducted between September, 2013 among drag racers and fans in East St. Louis. Oral cancer knowledge was derived from combining questionnaire items to form knowledge score. Covariates examined included age, sex, race, marital status, education status, income level, insurance status, tobacco and alcohol use. Adjusted linear regression analysis measured predictors of oral cancer knowledge. Results Three hundred and four participants completed questionnaire; 72.7% were African Americans. Smoking rate was 26.7%, alcohol use was 58.3%, and mean knowledge score was 4.60 ± 2.52 out of 17. In final adjusted regression model, oral cancer knowledge was associated with race and education status. Compared with Caucasians, African Americans were 29% less likely to have high oral cancer knowledge (β = -0.71; 95% CI: -1.35, -0.07); and participants with a high school diploma or less were 124% less likely to have high oral cancer knowledge compared with college graduates (β = -1.24; 95% CI: -2.44, -0.41). Conclusions There was lower oral cancer knowledge among African Americans and those with low education. The prevalence of smoking was also very high. Understanding predictors of oral cancer knowledge is important in future design of educational interventions specifically targeted towards high-risk group for oral cancer.
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Freiser ME, Cohen ER, Szczupak M, Desai DD, Lo K, Nayak C, Weed DT, Sargi ZB. Recruitment of underserved, high-risk participants to a head and neck cancer screening program. Laryngoscope 2016; 126:2699-2704. [DOI: 10.1002/lary.26035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Monika E. Freiser
- University of Miami Department of Otolaryngology; University of Miami Miller School of Medicine; Miami Florida
| | - Erin R. Cohen
- University of Miami Department of Otolaryngology; University of Miami Miller School of Medicine; Miami Florida
| | - Mikhaylo Szczupak
- University of Miami Department of Otolaryngology; University of Miami Miller School of Medicine; Miami Florida
| | - Dipan D. Desai
- University of Miami Department of Otolaryngology; University of Miami Miller School of Medicine; Miami Florida
| | - Kaming Lo
- Division of Biostatistics; Department of Public Health Sciences; University of Miami, and Biostatistics Collaboration and Consulting Core; Miami Florida U.S.A
| | - Chetan Nayak
- University of Miami Department of Otolaryngology; University of Miami Miller School of Medicine; Miami Florida
| | - Donald T. Weed
- University of Miami Department of Otolaryngology; University of Miami Miller School of Medicine; Miami Florida
| | - Zoukaa B. Sargi
- University of Miami Department of Otolaryngology; University of Miami Miller School of Medicine; Miami Florida
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Baggett TP, Chang Y, Porneala BC, Bharel M, Singer DE, Rigotti NA. Disparities in Cancer Incidence, Stage, and Mortality at Boston Health Care for the Homeless Program. Am J Prev Med 2015; 49:694-702. [PMID: 26143955 PMCID: PMC4615271 DOI: 10.1016/j.amepre.2015.03.038] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Homeless people have a high burden of cancer risk factors and suboptimal rates of cancer screening, but the epidemiology of cancer has not been well described in this population. We assessed cancer incidence, stage, and mortality in homeless adults relative to general population standards. METHODS We cross-linked a cohort of 28,033 adults seen at Boston Health Care for the Homeless Program in 2003-2008 to Massachusetts cancer registry and vital registry records. We calculated age-standardized cancer incidence and mortality ratios (SIRs and SMRs). We examined tobacco use among incident cases and estimated smoking-attributable fractions. Trend tests were used to compare cancer stage distributions with those in Massachusetts adults. Analyses were conducted in 2012-2015. RESULTS During 90,450 person-years of observation, there were 361 incident cancers (SIR=1.13, 95% CI=1.02, 1.25) and 168 cancer deaths (SMR=1.88, 95% CI=1.61, 2.19) among men, and 98 incident cancers (SIR=0.93, 95% CI=0.76, 1.14) and 38 cancer deaths (SMR=1.61, 95% CI=1.14, 2.20) among women. For both sexes, bronchus and lung cancer was the leading type of incident cancer and cancer death, exceeding Massachusetts estimates more than twofold. Oropharyngeal and liver cancer cases and deaths occurred in excess among men, whereas cervical cancer cases and deaths occurred in excess among women. About one third of incident cancers were smoking-attributable. Colorectal, female breast, and oropharyngeal cancers were diagnosed at more-advanced stages than in Massachusetts adults. CONCLUSIONS Efforts to reduce cancer disparities in homeless people should include addressing tobacco use and enhancing participation in evidence-based screening.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Boston Health Care for the Homeless Program, Boston, Massachusetts.
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bianca C Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Monica Bharel
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Massachusetts Department of Public Health, Boston, Massachusetts
| | - Daniel E Singer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Dwojak S, Deschler D, Sargent M, Emerick K, Guadagnolo BA, Petereit D. Knowledge and screening of head and neck cancer among American Indians in South Dakota. Am J Public Health 2015; 105:1155-60. [PMID: 25320895 PMCID: PMC4431103 DOI: 10.2105/ajph.2014.302177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We established the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians in South Dakota and determined whether head and neck cancer screening detected clinical findings in this population. METHODS We used the European About Face survey. We added questions about human papillomavirus, a risk factor for head and neck cancer, and demographics. Surveys were administered at 2 public events in 2011. Participants could partake in a head and neck cancer screening at the time of survey administration. RESULTS Of the 205 American Indians who completed the survey, 114 participated in the screening. Mean head and neck cancer knowledge scores were 26 out of 44. Level of education was the only factor that predicted higher head and neck cancer knowledge (b = 0.90; P = .01). Nine (8%) people had positive head and neck cancer screening examination results. All abnormal clinical findings were in current or past smokers (P = .06). CONCLUSIONS There are gaps in American Indian knowledge of head and neck cancer risk factors and symptoms. Community-based head and neck cancer screening in this population is feasible and may be a way to identify early abnormal clinical findings in smokers.
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Affiliation(s)
- Sunshine Dwojak
- Sunshine Dwojak, Daniel Deschler, and Kevin Emerick are with the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Michele Sargent and Daniel Petereit are with the John T. Vucurevich Cancer Care Institute at Rapid City Regional Hospital, Rapid City, SD. B. Ashleigh Guadagnolo is with the University of Texas M.D. Anderson Cancer Center, Houston
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