Targeted Screening Strategies for Head and Neck Cancer: A Global Review of Evidence, Technologies, and Cost-Effectiveness

Guntinas-Lichius, Orlando; Bücking, Claudio; Ng, Sweet Ping; López, Fernando; Rodrigo, Juan Pablo; Rao, Karthik N.; Pelaz, Andrés Coca; Kowalski, Luiz P.; Piazza, Cesare; Rinaldo, Alessandra; Ferlito, Alfio

doi:10.3390/diagnostics15162095

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Targeted Screening Strategies for Head and Neck Cancer: A Global Review of Evidence, Technologies, and Cost-Effectiveness

by

Orlando Guntinas-Lichius

^1,*

,

Claudio Bücking

¹,

Sweet Ping Ng

²,

Fernando López

³,

Juan Pablo Rodrigo

³

,

Karthik N. Rao

⁴

,

Andrés Coca Pelaz

³

,

Luiz P. Kowalski

^5,6

,

Cesare Piazza

⁷,

Alessandra Rinaldo

⁸

and

Alfio Ferlito

⁹

¹

Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany

²

Department of Radiation Oncology, Austin Health, Melbourne, VIC 3084, Australia

³

Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), The University Institute of Oncology of Asturias—Cajastur Social Programme (IUOPA), Centro de Investigación Biomédica en Red Cáncer (CIBERONC), 33011 Oviedo, Spain

⁴

Department of Head and Neck Oncology, Sri Shankara Cancer Foundation, Bangalore 560004, India

⁵

Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo 01509-900, Brazil

⁶

Head and Neck Surgery, Faculty of Medicine, University of Sao Paulo, Sao Paulo 05508-020, Brazil

⁷

Unit of Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, 25123 Brescia, Italy

⁸

ENT Unit, Policlinico Città di Udine, 33100 Udine, Italy

⁹

Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy

^*

Author to whom correspondence should be addressed.

Diagnostics 2025, 15(16), 2095; https://doi.org/10.3390/diagnostics15162095

Submission received: 23 July 2025 / Revised: 13 August 2025 / Accepted: 18 August 2025 / Published: 20 August 2025

(This article belongs to the Special Issue Advances in Precision Diagnosis of Head and Neck Tumors: From Clues to Clarity)

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Abstract

Head and neck cancer (HNC) is the seventh most common cancer worldwide, with rising incidence particularly in oropharyngeal cancer subsites. Despite well-known risk factors, such as tobacco and alcohol consumption as well as human papillomavirus (HPV) infection, most HNCs are diagnosed at an advanced stage, resulting in poor prognosis. Early detection and screening are critical, especially in high-risk populations. Nevertheless, there is a lack of guidelines for a stratified HNC screening. A systematic literature review was conducted following PRISMA guidelines, using PubMed and ScienceDirect databases up to 30 June 2025. Search terms included “screening”, “early diagnosis”, and specific HNC subsites. A total of 199 records were screened, and 160 studies were included based on relevance and scientific rigor. The review concentrates on contemporary screening modalities, stratification of high-risk cohorts, emerging technologies, and cost-effectiveness evidence. Visual inspection and panendoscopy remain the standard tools for HNC screening, but have limited effectiveness and cost-efficiency. Opportunistic screening in high-risk individuals, especially in regions with high HNC prevalence, has shown benefits. Liquid biopsy techniques targeting HPV- and Epstein-Barr virus-related HNC demonstrate high sensitivity for early detection and recurrence monitoring. Novel imaging technologies like narrow-band imaging and Raman spectroscopy show promising diagnostic accuracy but require further validation. Most broad-based screening programs lack cost-effectiveness, while targeted strategies in high-risk groups appear more viable. Screening for HNC should be stratified by individual risk profiles and regional disease prevalence. Emerging technologies, particularly liquid and optical biopsy techniques, offer transformative potential. Future screening strategies must integrate technological advances into tailored, evidence-based protocols to improve early detection and patient outcomes in HNC.

Keywords: head and neck cancer; cancer screening; opportunistic screening; early detection; high-risk populations; liquid biopsy; human papillomavirus (HPV); Epstein-Barr virus (EBV); cost-effectiveness; biophotonics

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MDPI and ACS Style

Guntinas-Lichius, O.; Bücking, C.; Ng, S.P.; López, F.; Rodrigo, J.P.; Rao, K.N.; Pelaz, A.C.; Kowalski, L.P.; Piazza, C.; Rinaldo, A.; et al. Targeted Screening Strategies for Head and Neck Cancer: A Global Review of Evidence, Technologies, and Cost-Effectiveness. Diagnostics 2025, 15, 2095. https://doi.org/10.3390/diagnostics15162095

AMA Style

Guntinas-Lichius O, Bücking C, Ng SP, López F, Rodrigo JP, Rao KN, Pelaz AC, Kowalski LP, Piazza C, Rinaldo A, et al. Targeted Screening Strategies for Head and Neck Cancer: A Global Review of Evidence, Technologies, and Cost-Effectiveness. Diagnostics. 2025; 15(16):2095. https://doi.org/10.3390/diagnostics15162095

Chicago/Turabian Style

Guntinas-Lichius, Orlando, Claudio Bücking, Sweet Ping Ng, Fernando López, Juan Pablo Rodrigo, Karthik N. Rao, Andrés Coca Pelaz, Luiz P. Kowalski, Cesare Piazza, Alessandra Rinaldo, and et al. 2025. "Targeted Screening Strategies for Head and Neck Cancer: A Global Review of Evidence, Technologies, and Cost-Effectiveness" Diagnostics 15, no. 16: 2095. https://doi.org/10.3390/diagnostics15162095

APA Style

Guntinas-Lichius, O., Bücking, C., Ng, S. P., López, F., Rodrigo, J. P., Rao, K. N., Pelaz, A. C., Kowalski, L. P., Piazza, C., Rinaldo, A., & Ferlito, A. (2025). Targeted Screening Strategies for Head and Neck Cancer: A Global Review of Evidence, Technologies, and Cost-Effectiveness. Diagnostics, 15(16), 2095. https://doi.org/10.3390/diagnostics15162095

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Targeted Screening Strategies for Head and Neck Cancer: A Global Review of Evidence, Technologies, and Cost-Effectiveness

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