An audit assessing if head and neck multi-disciplinary teams (MDTs) in hospital Trusts across England offer Fanconi anaemia (FA) testing for patients under the age of 45 with head and neck squamous cell carcinoma (HNSCC)


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Zain Sheikh1,2, Shahid Iqbal2, Hannah Blanchford2, James Adams2, Charles Kelly2
1Newcastle University, Newcastle upon Tyne, UK, 2Newcastle upon Tyne Hospital Trust, Newcastle upon Tyne, UK

Background

Fanconi Anaemia (FA) is an inherited bone marrow failure syndrome with an increased incidence of certain cancers, one of which is oropharyngeal squamous cell carcinoma (SCC) (3% of FA-affected individuals)¹. The UK & Ireland FA clinical network guideline state that ‘'all individuals aged under 45 years presenting with a SCC of mouth/tongue/tonsils/hypopharynx should be screened for FA with particular consideration being given for the possibility of reverse mosaicism''. The importance of testing is that FA patients are extremely sensitive to DNA cross-linking (platinum based) agents used to treat non-FA HNSCC. These agents can result in toxicities, organ failure and possibly fatalities² and FA status needs to be known before treatment commences. The aim was to To assess if trusts in England offer FA screening for patients under 45 years with HNSCC.

Method

A survey was designed which asked: If MDTs were aware of guidelines, if they routinely tested, if they did test - which sample type they used, where samples were sent and what their operational policy was.

The head and neck MDT coordinators nationally were called then emailed with the survey.

Results

MDTs were unaware of the guidelines and did not perform FA screening nor did they have an operational policy. From this it can be inferred there is no evidence of any screening being undertaken nationally.

Conclusion

FA screening guidelines in young patients with HNSCC are not well known and not being followed. The profile of FA needs to be raised, perhaps by integrating into education programmes and implement FA screening in patients under 45 years with HNSCC.