# Screening for second primary tumors in the aerodigestive tract in non-Asian populations with head and neck cancer – systematic review and meta-analysis

## TL;DR

This study reviews the effectiveness of screening for second primary tumors in non-Asian patients with head and neck cancer, finding a 5.4% overall prevalence.

## Contribution

The study provides the first meta-analysis on screening for second primary tumors in non-Asian populations with head and neck cancer.

## Key findings

- The pooled prevalence of second primary tumors in non-Asian patients was 5.4%.
- Most second primary tumors were detected in combination with hypopharynx carcinoma.
- Synchronous and metachronous tumors occurred in similar proportions (45.3% and 54.7%).

## Abstract

Patients diagnosed with a primary tumor in the esophagus, lungs, or head and neck are at an increased risk for developing second primary tumors (SPTs) in these regions. Most studies on SPT prevalence focus on Asian populations, with limited data available for non-Asian groups, leaving the utility of screening unclear. This review aims to assess the yield of screening for SPTs in non-Asian populations following a primary tumor in these regions.

A systematic literature search was conducted to identify studies on screening for esophageal, lung, or head and neck SPTs after a primary tumor diagnosis in any of these sites. The primary outcome was the prevalence by screening of all diagnosed SPTs in the esophagus, head and neck or lungs.

Due to limited data on screening for SPTs after esophageal or lung tumors, this review focused solely on screening after primary head and neck tumors. A total of 26 studies with 8071 patients from non-Asian countries were included. The pooled prevalence for all SPTs was 5.4% [95% confidence interval (CI) 4.1% to 7.2%]. The pooled prevalence for esophageal SPTs individually was 5.3% (95% CI 3.7% to 7.7%), for head and neck SPTs 4.6% (95% CI 1.0% to 18.1%) and for lung SPTs 4.0% (95% CI 2.6% to 6.2%). Most SPTs were detected in combination with an index hypopharynx carcinoma (60.0%). The proportion of synchronous (45.3%) and metachronous (54.7%) SPTs was similar.

Endoscopic screening for esophageal SPTs in non-Asian countries should be considered, especially in patients with a primary hypopharynx carcinoma.

•Research on the yield of screening for SPTs in the esophagus, head and neck or lungs is scarce in non-Asian populations.•The pooled prevalence for SPTs in head and neck, esophagus or lungs after a primary HNC diagnosis was 5.4%.•The proportion of synchronous (45.3%) and metachronous (54.7%) SPTs was similar after a primary HNC diagnosis.•Screening for esophageal SPTs in non-Asian countries should be considered, especially in primary hypopharynx carcinoma.

Research on the yield of screening for SPTs in the esophagus, head and neck or lungs is scarce in non-Asian populations.

The pooled prevalence for SPTs in head and neck, esophagus or lungs after a primary HNC diagnosis was 5.4%.

The proportion of synchronous (45.3%) and metachronous (54.7%) SPTs was similar after a primary HNC diagnosis.

Screening for esophageal SPTs in non-Asian countries should be considered, especially in primary hypopharynx carcinoma.