Why are head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factors

Context: Late stage diagnosis of Head and Neck Squamous Cell Carcinoma (HNSCC) makes the prognosis worse. However, the influence of inequalities of health care and socio-economic factors has never been investigated in this pathology. Objectives: To identify any inequalities in health care and socio-economic factors influencing late-stage diagnosis of HSNCC. Design: The ASED study (Acces aux Soins avant Endoscopie Diagnostique) was a cross-sectional observational, multi-centric (19 centers) study on metropolitan French territory. Data was collected from 1st December 2010 to 30th June 2012. Setting: Patients were included prospectively in Head and Neck Surgery departments. A self-administered form was completed by the patients at the time of ambulatory diagnostic endoscopy (38 items describing demographic, socio-economic and health care access characteristics). A second form was completed by the surgeon at the time of histological confirmation of HNSCC (11 items describing the tumor). Patients: Six hundred and ninety patients aged 18 or more with a first HNSCC were included. Exclusion criteria were second HSNCC or loco-regional recurrence of HNSCC. Main Outcome measure(s): Late-stage was defined as T3/T4 tumor, and early-stage was defined as T1/T2 tumor, according to the TNM classification. Results: Independent factors associated with late-stage diagnosis were: hypopharyngeal location (OR = 3.5 [1.8-7.3] versus oral cavity location), age (OR = 1.02 [1.00-1.04]), male sex (OR = 1.7 [1.1-2.6]) and being born in France (OR = 2 [1.2-3.3]). Factors associated with early-stage diagnosis were previous consultation to a specialist physician (OR = 0.5 [0.4-0.8]), ease of access to this specialist (OR = 0.6 [0.4-0.9]), and having a health professional in close contact (OR = 0.6 [0.4-0.8]). Time to consultation was identical in both groups. No significant association was found between socio-economic factors (especially deprivation or alcohol and tobacco consumption) and late-stage diagnosis of HNSCC. Conclusion: Health care access in France plays a major role in the stage of HNSCC at diagnosis. Easy access to a specialist protects from late-stage diagnosis. Absence of socio-economic factors may be due to the French social security system and its comprehensive coverage of the population. (C) 2013 Elsevier Ltd. All rights reserved.