STEP 1: Prevention and early detection

This step outlines recommendations for the prevention and early detection of head and neck cancer.

Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).

Recommendations for preventing head and neck cancer include:

  • smoking cessation – all patients who currently smoke (or have recently quit) should be offered best practice tobacco dependence treatment, an opt-out referral to a behavioural intervention service such as Quitline, and prescribed smoking cessation pharmacotherapy, if clinically appropriate; conversations about smoking can be framed using the Ask, Advise, Help model:
    • ask all patients about smoking status and document in their medical record
    • advise all patients who smoke to quit in a clear, non-confrontational and personalised way, and advise of the best way to quit
    • help all patients who smoke to quit by offering a referral for behavioural intervention (e.g. Quitline) and prescribing pharmacotherapy (e.g. nicotine replacement therapy), if clinically appropriate
  • avoiding exposure to second-hand tobacco smoke – smoking cessation care should be offered to the patient’s partner (and significant others) who smoke
  • avoiding or reducing alcohol intake, ultraviolet (UV) exposure and occupational exposure to asbestos, wood dust, nickel alloy and silica dust
  • vaccinating against the human papillomavirus (HPV) – follow recommended guidelines against protection from HPV (Australian Government Department of Health 2018)
  • good oral hygiene including well-fitting dentures to prevent ulceration
  • eating healthily as per the Australian dietary guidelines (Eat for Health 2015) and maintaining a healthy body weight.

The most important risk factor for developing head and neck cancer is tobacco use (Jethwa & Khariwala 2017). Combined tobacco and alcohol use has a synergistic effect on the risk of developing head and neck cancer, with people who frequently smoke and consume alcohol being at the highest risk (Hashibe et al. 2009).

Risk factors for developing head and neck cancer include:

  • smoking, chewing tobacco or chewing betel quid
  • alcohol consumption
  • HPV exposure (Kobayashi et al. 2018)
  • UV skin exposure (for skin cancer)
  • pre-existing oral lesions
  • poor oral hygiene
  • age (over 40 years)
  • sex (male)
  • Epstein-Barr virus infection in genetically predisposed individuals (for nasopharyngeal cancer)
  • immunosuppression
  • ionising radiation exposure
  • inherited conditions including Fanconi’s anaemia, ataxia-telangiectasia syndrome, Bloom’s syndrome and Li-Fraumeni cancer syndrome
  • poor nutrition.

People with lower income and other disadvantaged groups are at greater risk of head and neck cancer. This includes Aboriginal and Torres Strait Islander people, who are more likely to develop head and neck cancer, including oral cancer, than non-Aboriginal people.

Everyone should be encouraged to reduce their modifiable risk factors, including taking the steps outlined in section 1.1.

There are currently no formal screening programs in Australia for detecting head and neck cancer. Opportunistic screening should be conducted during general health examinations and dental check-ups.