Head and neck cancer screening: Bridging gaps in early detection and equity

Head and neck cancers (HNCs) represent a major global health challenge, ranking among the top ten cancers by incidence and mortality. India bears a disproportionate burden, accounting for 26.9% of the worldwide 890,000 cases in 2022, 239,817 new diagnoses per GLOBOCAN and ICMR-NCDIR estimates, with South Asia contributing one-third of global oral and pharyngeal cancers. High-risk behaviors drive this epidemic. Tobacco use affects 267 million Indians (bidis, khaini, gutkha prominent), alongside betel quid chewing, alcohol synergy, HPV (26% HNC prevalence), poor oral hygiene (>60% rural untreated dental issues), and malnutrition (13.7% undernourished). Government efforts like the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) and Ayushman Bharat have screened 328 million people for oral cancer by 2023 using ASHA/ANM visual exams, mobile units (1,525 operational), and teleoncology platforms like OncoNet. Yet NFHS-5 data (2019-2021) show stark gaps: just 1.2% of men and 0.9% of women aged 30-49 screened, varying from 0% in Ladakh to 12-15% in southern states. Late presentations yield 30-50% five-year survival, versus 70% in developed nations. This review synthesizes HNC epidemiology, regional/gender disparities, India-specific risks, screening landscapes, and barriers: workforce shortages, stigma, low awareness, financial strains, and digital divides. Targeted interventions like structured screening, HPV vaccination scale-up, could halve mortality as cases are predicted to double by 2050.