Determinants of compliance with an early detection programme for cancer of the head and neck in north-eastern Italy

An early detection programme for cancer of the head and neck (H&N) has been conducted from January 1991 to January 1993 in Pordenone province, north-eastern Italy, an area with very high mortality rates for cancers in those sites. 627 high-risk individuals (491 males, median age 57 years and 136 females, median age 47 years) (i.e. smokers and/or drinkers of more than a half litre of wine or equivalent per day) were referred to a research nurse by 21 general practitioners. An educational message on the health hazards of tobacco and alcohol abuse was delivered together with an invitation to undergo a free ear, nose and throat (ENT) examination at a nearby hospital. 212 individuals (34%) underwent the ENT visit. The influence of various individuals' characteristics on the lack of compliance was assessed. Female sex and absence of ENT symptoms were associated with a more than two-fold higher lack of compliance. Current smokers were more than three-fold less likely to accept the invitation to undergo the examination. Conversely, alcohol intake and, within smokers, the amount smoked seemed unimportant. This study shows that the correct identification of high-risk individuals is expensive and the compliance with a H&N cancer early detection programme relatively low, especially among smokers.