Academic Head and Neck Surgery: Educating Our Future

In addition to a continued and future need for clinicians to care for these tobacco-associated squamous carcinomas of the head and neck, we are seeing greater numbers of these cancers (particularly oropharyngeal cancers) in never-smokers, presumably caused by a rising population prevalence of oncogenic human papillomavirus.

These trends in the head and neck cancer population, along with the rising incidence of thyroid carcinoma, melanoma, and nonmelanoma skin cancers, will all necessitate a substantial head and neck surgical manpower with a more broad-based skill set.

Given the constant evolution of head and neck cancer care, the coming complexity of highly individualized care, and the pressures for efficient quality and safe care with proven outcomes (in other words cost-effective care), most malignancies of the head and neck will (and should) continue to gravitate toward academic medical centers.

‘More and more otolaryngology residents seem to have lost interest in head and neck surgery as well, with more fellowship positions available than we can fill.’

To reduce the public health burden of squamous carcinoma of the head and neck, we, as academic head and neck surgeons, support efforts at tobacco, alcohol, and human papillomavirus control, but it is principally the survival and mortality rates which we can directly influence. To that end, most in the field advocate that squamous carcinomas of the upper aerodigestive tract should wherever possible be initially treated at academic medical centers and comprehensive cancer centers. To support this goal, we must provide the future well-trained head and neck surgeons capable of providing such tertiary care.

Adapt with a Changing Field

2) The field is changing and the future head and neck surgeon must adapt to this new role.

The makeup of the head and neck practice is evolving from one principally dedicated to the treatment of tobacco and alcohol associated squamous carcinomas of the upper aerodigestive tract to one much more diverse in terms of histologies and etiologies, but also in terms of guiding patients through a complex multimodal treatment plan and rehabilitation.

While it is true that the prevalence of smoking has dramatically dropped and continues to do so, and that the incidence and mortality of oral cavity, hypopharyngeal, and laryngeal cancer has followed, the incidence of oropharyngeal cancer has not changed and the incidence of oropharyngeal (and oral tongue) cancer is actually rising among young adults.

Among women, thyroid cancer (chiefly papillary thyroid carcinoma) is the most rapidly increasing in incidence of all malignancies. In fact, this year it is estimated that 30,000 new cases of thyroid cancer will be diagnosed, numbers equal to the number of new oral cavity and laryngeal cancers combined. Among men, melanoma is the most rapidly increasing in incidence of all malignancies, and this year approximately 15,000 to 20,000 new melanomas of the head and neck region will be diagnosed, a number almost equivalent to the number of new cases of oral cavity cancer.