Sputum cytologic diagnosis of upper respiratory tract cancer. Second report

Screening for cancer is a popular issue for debate because few, if any, evaluations of the screening process have been conducted on a long-term prospective basis with use of concomitant, unscreened controls. We have found that screening of high-risk persons for presymptomatic lung cancer will identify patients with cancer in the upper and lower respiratory passages. Randomly selected patients enrolled in the Mayo Lung Project have undergone sputum cytologic and chest roentgenographic screening at four-month intervals and were compared with randomly selected matched control subjects who were not intensively screened. The search for upper airway tumors in the head and neck region was instigated by abnormal findings on sputum cytology in 12 screened patients. In the same period, 12 other screened patients with abnormal results of sputum cytology were found to have roentgenographically "occult" lung cancer. This finding emphasized the importance of the otorhinolaryngologic examination in screening programs for airway cancer. It is also important to emphasize that sputum-negative patients may have obvious, symptomatic tumors of the upper aerodigestive tract that can be easily diagnosed by those who are skilled in examining this area. Contrary to our expectation, there is no definitive evidence that screening has reduced mortality from either upper or lower airway cancer.