Impact of esophageal screening in patients with head and neck cancer

We have reviewed the records of 1,982 patients who were treated for head and neck cancer or esophageal cancer from 1962 to 1986. Forty-one patients had primary cancer at both sites. Twenty-one cases of these multiple primaries occurred synchronously and twenty were metachronous. The overall incidence of esophageal cancer in our head- and neck-cancer patients was 2.5 per cent and the incidence of head and neck cancer in our esophageal cancer patients was 7.1 per cent. From 1980 to 1986, 574 cases with a diagnosis of head and neck or esophageal cancer were routinely screened for other aerodigestive malignancies at the time of initial diagnosis. From this group, only six patients had simultaneous lesions of the head and neck and esophagus with only one asymptomatic esophageal carcinoma. Median survival of all 41 multiple primary patients after diagnosis of esophageal cancer was 5.3 months. Two- and three-year survivals were 6.7 per cent and 0 per cent, respectively. There was no significant survival difference for lesions diagnosed simultaneously, synchronously, and metachronously before 1980 or after 1980. All patients died with uncontrolled esophageal cancer except for one patient who died of head- and neck-cancer recurrence. Our experience indicates that active screening of head- and neck-cancer patients for simultaneous esophageal cancer has a low yield and there appears to be no survival advantage for these patients compared with those with subsequently diagnosed esophageal tumors.