Key Points:
- Patients with non-thyroid HNC were 17.1 (95%CI: 9.55-30.6,
p<0.001) times more likely to have cancer-related death
found at autopsy than patients with thyroid carcinoma.
- 50% of patients with laryngeal carcinomas diagnosed at autopsy had
their primary cause of death listed as laryngeal cancer.
- Biological and psychosocial factors may contribute to the delayed
diagnosis of head and neck cancers.
- The high rate of cancer-related deaths in postmortem diagnosis of
non-thyroid head and neck cancers reveals the need for health care
professionals to increase vigilance in detecting these cancers in
order to prevent misdiagnoses.
- It is imperative the otolaryngology community improves awareness of
asymptomatic head and neck cancer patients and emphasizes the need to
improve screening in those who may be high risk for disease
development. OBJECTIVES
Head and neck cancers (HNC) accounted for 3% of all cancer diagnoses in
the United States (51,540 cases) and 1.5% of cancer-related deaths
(10,030 cases) in 2018.1,2 Autopsy of patients with
underlying HNC is germane to understanding the complex causes of death
associated with these cancers and is important for quality improvement
across medicine.
This study reviewed patients with
HNCs diagnosed for the first time at autopsy. We theorized both thyroid
and non-thyroid HNCs diagnosed at autopsy would be incidental findings
characterized by low T stage and nodal burden. Previous studies have
extensively characterized the prevalence of thyroid cancer upon
autopsy.3-5 Our study emphasizes the prevalence of
non-thyroid HNCs first diagnosed upon autopsy utilizing thyroid cancer
as a comparative measure. It is important to distinguish between the two
disease processes as even at lower stages, non-thyroid cancers, because
their malignant nature, may have greater influence on patient mortality
than thyroidal cancer. Neither cancer diagnosed at autopsy has been
studied using a national cancer database. This study will inform
clinicians and public health officials about the frequency and
characteristics of undiagnosed HNCs and subsequent missed treatment
opportunities. Because of the malignancy of non-thyroid cancers, the
medical community must be aware of their prevalence, particularly in
cases where patients may be asymptomatic. This understanding is
imperative to improve screening and early care measures for patients at
risk for disease development or progression based on demographic
characteristics and modifiable risk factors.