Barbados doctors urged to strengthen high-risk screening for head & neck and thyroid cancers

By Tracy Moore

Barbadian doctors are being urged to adopt targeted, high-risk screening for head and neck cancers, as global incidence continues to rise and new thyroid cancer guidelines reshape early detection strategies.

Delivering a comprehensive presentation at the Barbados Association of Medical Practitioners (BAMP) annual conference, the Ear, Nose and Throat (ENT) Specialist from the Queen Elizabeth Hospital, Dr Salonee Shenoy, said that, unlike breast or prostate cancer, routine population-wide screening is neither practical nor effective for head and neck malignancies.

“In the general population, it is not recommended due to low prevalence and potential for false positives,” she explained. “The key is to identify high-risk groups… individuals with elevated risk factors such as heavy smokers, alcohol users, HPV-positive individuals, and patients with a history of genetic or familial thyroid cancers.”

Dr Shenoy noted that head and neck cancers now account for 650 000 new cases annually, with the highest burden in India, Pakistan, Eastern Europe, and parts of Asia. By 2030, she said, head and neck mucosal cancers are projected to increase by 30% globally.

She added that thyroid cancer, particularly in women, is also rising worldwide: “Thyroid cancers are increasing in incidence, especially in women, and that necessitates a need for increased awareness.”

While Barbados and the wider Caribbean have relatively low prevalence rates compared to other regions, she warned that the island must remain vigilant. However, the ENT specialist emphasised that universal screening can create more harm than benefit.

“Screening may be inefficient… it may lead to unnecessary procedures, false positives, and over-diagnosis,” she said. “There is no proven mortality benefit.”

Instead, she urged medical practitioners to conduct regular oral cavity examinations in patients with known risk factors and to remain alert to pre-malignant lesions such as leukoplakia, erythroplakia, oral lichen planus, and submucosal fibrosis. These lesions, she said, warrant close monitoring because many carry 20–30 per cent malignant potential.

She also outlined several critical early-warning signs that demand urgent referral to ENT specialists. These include: non-healing mouth sores, persistent throat discomfort, dysphagia or odynophagia, voice changes lasting more than six weeks, unilateral ear pain, unexplained tooth mobility, and persistent neck masses.

“Any lesion that is suspicious, anything lasting for more than three weeks, warrants urgent referral,” she stressed.

Turning to thyroid cancer, Dr Shenoy highlighted significant updates in the 2025 World Health Organisation 5th edition of tumour classification and explained that the TR1–TR5 scoring system determines whether a thyroid nodule requires biopsy.

With the rise of high-resolution ultrasound, liquid biopsies, molecular marker testing, and AI-assisted diagnostics, Dr Shinoy expects earlier detection of clinically meaningful disease among high-risk groups.

Her guidance to clinicians was clear: “Screening should be targeted, not universal. Patient education is crucial. Diagnosis must use the tools available – ultrasound, biopsy, molecular markers, and imaging – to stratify risk accurately.”

She said future directions include personalised screening, AI integration, and improved biomarker discovery.