Head and Neck Cancer Screening

Unlike cancers such as breast, cervical, and colorectal cancer, there is currently no standard routine screening program for head and neck cancers for people at average risk who do not have symptoms. Head and neck cancers include several different diseases that can develop in the mouth, throat, voice box, nasal cavity, sinuses, and salivary glands. Because there is no single screening test that can reliably detect all of these cancers early, recognizing symptoms and having concerning changes evaluated are especially important. For oral cavity and nasopharyngeal cancers specifically, the National Cancer Institute reports that there are no standard or routine screening tests proven to reduce the risk of dying from these cancers.

Is there a routine screening test for head and neck cancer?

There is currently no routine screening test recommended for the general population that can detect all head and neck cancers. Screening tests must be able to find cancer in people who do not have symptoms and must provide enough benefit to outweigh possible harms such as false-positive results, unnecessary biopsies, or additional testing. For oral cancer, the U.S. Preventive Services Task Force has concluded that there is not enough evidence to determine whether routine screening of asymptomatic adults by primary care clinicians provides more benefit than harm. This does not mean that examinations of the mouth and throat are unimportant. Healthcare providers and dentists may identify suspicious areas during routine care, especially in people with known risk factors.

What happens during an oral cancer exam?

During an examination, a healthcare provider or dentist may visually inspect and feel areas of the mouth and neck. They may look at:

• The lips

• Gums

• Tongue

• Inner cheeks

• Roof and floor of the mouth

• Back of the throat

• Tonsil area

They may also feel the jaw and neck for enlarged lymph nodes or unusual lumps. If an abnormal area is found, additional evaluation may be needed.

Can a dentist detect head and neck cancer?

Dentists regularly examine the mouth and surrounding tissues and may notice changes that require further evaluation. Examples include:

• A sore that does not heal

• Red or white patches

• An unexplained lump

• Changes on the tongue

• Persistent swelling

• Unusual bleeding

A dental exam cannot rule out all head and neck cancers, particularly cancers that begin deeper in the throat or other areas that are difficult to see. Regular dental visits are still valuable for oral health and can provide an additional opportunity to identify concerning changes. The CDC recommends regular medical and dental care as part of oral cancer prevention and early detection efforts.

Is there a screening test for HPV-related throat cancer?

There is currently no recommended routine screening test for HPV-related oropharyngeal cancer in people without symptoms. An HPV test used for cervical cancer screening does not screen the mouth or throat for cancer. Although researchers are studying ways to identify people at higher risk of HPV-related throat cancers, there is currently no standard oral HPV test that is recommended as a cancer screening test for the general population. HPV vaccination remains an important way to prevent new infections with the HPV types that can cause oropharyngeal cancer.

Who may need closer monitoring?

People with certain risk factors may need more careful evaluation during routine medical or dental care. These risk factors include:

• Current or previous tobacco use

• Heavy alcohol use

• A combination of tobacco and alcohol use

• A previous head and neck cancer

• Significant exposure to certain occupational or environmental substances

• Certain immune system conditions

• Other individual risk factors

A history of head and neck cancer is itself associated with a higher risk of developing another head and neck cancer. Your healthcare team can determine what type of follow-up is appropriate based on your individual risk.

Know the possible warning signs

Because there is no routine screening program for most head and neck cancers, it is important to recognize changes that could require evaluation. Possible symptoms include:

• A mouth sore that does not heal

• A red or white patch in the mouth

• A lump or thickened area in the mouth

• A persistent sore throat

• Hoarseness or a change in your voice

• Difficulty or pain when swallowing

• A feeling that something is stuck in the throat

• A lump or swelling in the neck

• Persistent ear pain, especially on one side

• Numbness of the tongue, lip, or other area of the mouth

• Difficulty moving the jaw or tongue

• Unexplained bleeding in the mouth

• Persistent nasal congestion, especially on one side

• Frequent nosebleeds

• Unexplained facial swelling, numbness, or pain

These symptoms are often caused by conditions other than cancer. However, symptoms that persist, worsen, or do not have an obvious explanation should be evaluated by a healthcare professional.

What happens if your doctor finds something suspicious?

If an abnormal area is identified, your healthcare provider may recommend additional testing. Depending on where the abnormality is located, this may include:

• A more detailed physical examination

• Examination by an ear, nose, and throat specialist

• Endoscopy to examine areas of the nose or throat

• Imaging such as CT or MRI

• A biopsy

A biopsy removes a small sample of tissue so that a pathologist can examine it under a microscope. A biopsy is usually needed to confirm whether a suspicious area is cancer. Once cancer is diagnosed, additional testing may be used to determine where it started and whether it has spread.

When to get checked

You do not need to wait for a routine screening appointment if you notice a concerning change. Talk with a healthcare provider or dentist if you develop a sore, lump, voice change, swallowing problem, neck mass, or other unusual symptom that persists or continues to worsen. People who use or previously used tobacco, drink alcohol heavily, or have other head and neck cancer risk factors should also discuss their personal risk with their healthcare or dental provider.

Although there is no routine screening test for most head and neck cancers, paying attention to persistent symptoms and having them evaluated promptly can help cancers be diagnosed as early as possible.