title: Why are head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factors.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To identify any inequalities in health care and socio-economic factors influencing late-stage diagnosis of HSNCC.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Biostatistics, Pitié-Salpêtrière Hospital, Paris, France. Electronic address: judithadrien@free.fr.
authors.forename: J
authors.initials: J
authors.lastname: Adrien
authors.affiliation: Department of Maxillo-facial Surgery, Pitié-Salpêtrière Hospital, Paris, France. Electronic address: chloe.bertolus@psl.aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Bertolus
authors.affiliation: Clinical Research Unit, Pitié-Salpêtrière Hospital, Paris, France. Electronic address: laetitia.gambotti@psl.aphp.fr.
authors.forename: L
authors.initials: L
authors.lastname: Gambotti
authors.affiliation: Department of Biostatistics, Clinical Research Unit, Pitié-Salpêtrière Hospital, Paris, France. Electronic address: alain.mallet@psl.aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Mallet
authors.affiliation: Department of Head and Neck Surgery, Tenon Hospital/Pierre and Marie Curie University, Paris, France. Electronic address: bertrand.baujat@tnn.aphp.fr.
authors.forename: B
authors.initials: B
authors.lastname: Baujat
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Head and neck cancer; Health care access; Socio-economic factors; Stage at diagnosis