Nasopharyngeal Carcinoma: An Awareness and Screening Initiative in Boston’s Chinatown

Aims: Our objective is to describe our institutional experience with nasopharyngeal carcinoma (NPC), and the initiation of a community education and screening program.
Study Design: Retrospective case series; academic medical center.
Methodology: All cases of NPC treated at our institution between 1995 and 2009 were included; in total, 63 consecutive cases. Initially a retrospective review of patient characteristics was performed (Phase 1). Information reviewed included stage at presentation, completion of primary treatment and follow-up greater than 1 year. Findings of Phase 1were interpreted as demonstrating an issue in communication between the medical center and the community of patients at large. As such, a community education and screening program was instituted as part of an attempted community outreach program (Phase 2). The primary goals were to increase awareness about this disease, symptoms requiring evaluation and to educate patients about the resources available to them.
Results: At the time of diagnosis, 67% of patients with NPC presented with advanced-stage (III,IV) disease. Of the patients treated with curative intent, only 76% fully completed their plan of treatment. Also of note, only 60% of patients were seen in follow-up at 1-year post-treatment. A community education and screening program was initiated in order to address a presumed gap in provider-patient communication. To date a total of 176 patients have been screened; with approximately 10% warranting further diagnostic evaluations.
Conclusions: Although NPC is an unusual diagnosis in the United States, it is a common entity in the immigrant Cantonese population that live in Boston’s Chinatown. A review of the characteristics of our patient population with NPC led to a community awareness and screening initiative, which has sought to achieve earlier diagnosis and improved continuity of care for patients.