Biology and chemoprevention of head and neck cancer

Head and neck cancer, which represents only 5% of all cancer cases in the United States, remains an important public health problem. These cancers have one of the lowest long-term survival rates among common malignancies and are associated with significant morbidity despite advances in early diagnosis, management, and tobacco cessation programs. The high frequency of second primary cancers and their significant impact on survival are other unique aspects of this malignancy which contribute to its dismal prognosis. Chemoprevention efforts based on the biologic concepts of field cancerization and multistep tumorigenesis and the clinical activity of retinoids have already produced evidence of efficacy. Our knowledge of the mechanisms of carcinogenesis has been expanded through incorporation of the study of biomarkers in chemoprevention trials. Our current understanding of the biology of head and neck cancer, gained through such translational studies and advances in molecular biology and genetics, will be discussed in this review.