安徽省淮河流域癌症筛查的发展现状与展望

摘 要：癌症作为我国居民主要死亡原因之一,严重影响居民健康。针对高危人群开展癌症筛查是降低癌症疾病负担的最有效途径。安徽省淮河流域癌症筛查与早诊早治项目在各级党委和政府的领导下取得了显著成就。全省癌症防治体系逐步形成,癌症筛查覆盖面逐年扩大。但癌症筛查工作还存在不足,需持续推进癌症筛查和早诊早治工作,完善规范化及长效化的癌症筛查工作机制,加大癌症宣传教育力度,提升居民生存质量。     

城市癌症筛查对象与社区居民的肿瘤相关行为对照分析

摘 要：［目的］ 评价“中国城市癌症早诊早治项目”中基于问卷评估的临床筛查推介机制对高危人群的区分能力大小。［方法］ 采用自行设计的癌症危险因素调查表,对合肥市社区居民和接受医院筛查的居民开展平行调查,并比较两个人群癌症相关因素的暴露水平。［结果］ 相对明确的肿瘤危险因素在两个人群中差异有统计学意义,且均为医院筛查人群高于社区人群;有近半数的肿瘤保护因素在两个人群中的分布不存在统计学显著性差异。［结论］ “中国城市癌症早诊早治项目”中的基于问卷评估的临床筛查推介机制对癌症危险因素的区分能力较强;对癌症保护因素的反向区分能力较弱。“中国城市癌症早诊早治项目”筛查问卷对癌症相关因素的识别具有一定的“外推”作用。     

中国癌症筛查的发展、现状与挑战

摘 要：癌症是我国的重大公共卫生问题,严重威胁我国居民健康。为减轻癌症造成的疾病负担,在党和政府的有力领导下,我国在癌症筛查和早诊早治方面取得了显著的成就。现今我国癌症筛查体系日趋成熟,常见高发癌种的筛查与早诊早治项目逐渐推广和普及。但我国癌症筛查工作仍存在诸多不足,政府仍需根据目前癌症筛查现状制定和推行相应政策,多措并举以提高我国癌症筛查效果。     

癌症筛查与早诊早治的研究进展

癌症是严重威胁人类生命健康的疾病之一,已经成为全球的公共卫生问题。目前癌症患者晚期较多,导致生存率较低,如果癌症能够早期发现,会大大提高生存率,降低癌症的疾病负担。目前肿瘤的筛查与早诊早治是肿瘤二级预防的主要手段,能够早发现、早诊断和早治疗,提高患者生活质量。本文从几大高发癌种对目前癌症筛查现状、成效以及筛查方法进行阐述,以期为科学、合理选择和推广适宜的癌症筛查策略提供参考。     

推进农村地区癌症早诊早治 提高居民健康水平

摘 要：对癌症高危人群实行筛查策略是降低癌症负担的重要方式。为降低农村地区消化道恶性肿瘤负担,我国于2007年启动了一项人群为基础的癌症筛查项目,针对项目地区符合纳入标准的高危人群开展消化道恶性肿瘤的筛查与早诊早治工作。在党中央和各级政府的领导下,农村地区癌症防治体系逐步完善,癌症筛查与早诊早治水平显著提升,居民生活质量也大幅度提升。     

2016—2022年河北省城市居民上消化道癌筛查和随访结果分析

[目的]分析2016—2022年河北省城市癌症早诊早治项目的上消化道癌筛查和随访数据。[方法]按照河北省城市癌症早诊早治中上消化道癌筛查流程,在石家庄市、唐山市、邢台市和邯郸市社区选定年龄40～74岁的当地居民,通过问卷调查之后采用国家癌症中心依据“哈佛癌症风险指数”设计的统一评估模型评估出高危人群,进一步通过内镜检查、病理活检以及随访,发现上消化道癌病变情况。将上消化道癌确诊病例分为筛查组与未筛查组,对两组病理特征进行对比分析。[结果] 2016—2022年共计对河北省210 381名居民进行了高危评估,其中47 748人被评估为上消化道癌高危,高危率为22.70%。11 946人参与了内镜检查,参与率为25.02%。经过病理诊断,共检出了31例胃癌,12例食管癌,229例胃癌癌前病变,62例食管癌癌前病变,检出率分别为0.26%、0.10%、1.92%、0.52%。经过初筛和随访后,共计473例确诊为上消化道癌,累积发病率为0.22%,其中筛查组为66例,累积发病率为0.55%;未筛查组为407例,累积发病率为0.21%。筛查组的早期（0期+Ⅰ期）胃癌和食管癌确诊患者分别占66.6...     

乌鲁木齐市2015~2016年度城市居民癌症高风险人群筛查分析

目的 了解乌鲁木齐市2015~2016年度城市癌症早诊早治筛查情况,为下年度开展癌症早诊早治项目工作提供依据.方法 选择乌鲁木齐市的高新区(新市区)、水磨沟区、米东区、经济技术开发区、乌鲁木齐县和达坂城区6个项目区作为筛查现场,选择整群抽样的方法,对40~69岁常住居民,开展肺癌、肝癌、乳腺癌、上消化道癌和结直肠癌5大类癌症的流行病学调查和高风险评估.对检出的高危人群进行免费的临床筛查,探讨新疆城市癌症早诊早治的防治效果.结果 共完成高危人群评估50711人,评估出高危人群52655人次,完成临床检查12420人次,其中肺癌3708人次,乳腺癌2649人次,肝癌2919人次,上消化道癌1920人次,结直肠癌1224人次,总任务完成率为124.2%.乳腺癌参与率最高(37.0%),结直肠癌参与率最低(11.8%).共筛查出阳性病例1010例,确诊癌症24例,癌症检出率为193/10万.癌症患者中早期病例19例(79.1%),23例接受治疗,治疗率为95.8%.结论 有针对性对城市高风险人群进行筛查,能够发现早期肿瘤患者.仍需加强癌症防治宣传力度,优化项目筛查流程,提高参与项目的积极性,提高项目筛查效果.     

中国城市癌症早诊早治项目筛查依从性及影响因素研究

摘 要：癌症防治是“健康中国”行动计划的重要组成部分。中国城市地区癌症负担正在呈现逐年加重的态势,中国城市癌症早诊早治项目被认为可有效提高癌症早诊率,降低癌症死亡率。在癌症筛查过程中,参与者的依从性是影响实际筛查效果的重要因素之一。全文总结了中国城市癌症早诊早治项目各承担省市的筛查依从性现状与影响因素,认为加大对居民的健康教育宣教和服务力度,加强医务人员人才队伍建设,制定适合不同地区和人群的个性化筛查方案和技术对于提升筛查依从性至关重要。     

黑龙江省2013—2014年度城市癌症筛查分析

目的 评价2013—2014年度黑龙江省城市癌症早诊早治项目筛查结果 的意义。方法 在黑龙江省哈尔滨市和大庆市常住人口中,通过危险因素问卷调查评估出高危人群,分别进行相应的临床筛查(肺癌、肝癌、乳腺癌、上消化道癌和结直肠癌),探讨黑龙江省癌症早诊早治的防治效果。结果 2013—2014年度黑龙江省城市癌症早诊早治项目工作,共邀请了15628人参加临床筛查,临床筛查高危人群10299人次,共筛查出66例疑似癌症病例。结论 黑龙江省顺利的完成了2013—2014年度城市癌症早诊早治项目,早诊早治项目可以做到早发现、早诊断和早治疗的目的,对于提高检出癌症患者的生存时间和生存质量具有重要的意义,此项目也为黑龙江省在癌症早诊早治方面的工作积累了经验。     

癌症筛查和早诊早治——实现全民健康助力全面小康

摘 要：癌症防治工作是“打赢脱贫攻坚战，助力小康社会全面建成”的重要环节。开展常见癌症筛查和早诊早治，对改善癌症患者生存率和降低死亡率有重要意义，可显著降低居民因病致贫、因病返贫的可能性，亦是实现全民健康的重要措施。     

广州市越秀区常见恶性肿瘤的早发现及早诊断

目的：探索城市社区常见恶性肿瘤防治研究的模式。方法：以广州市越秀区（纯城市社区）为研究对象,从癌症健康教育和培训肿瘤防治骨干入手,以初级保健网为基础建立三级肿瘤防治网和肿瘤登记报告制度,通过筛查与基层咨询相结合手段,以求早期发现常见癌癌。实施的方法经质量评估,以求总结出一套可行的社区肿瘤防治模式。结果：建立了三级肿瘤防治网和肿瘤登记制度;培养了一批肿瘤防治骨干;设立了七个肿瘤监测中心和监测站,并开展了早诊早治工作;居民接受防癌健康教育后积极参与肿瘤筛查;总结经验撰写《社区肿瘤学》并正式出版发行。结论：城市肿瘤足于社区,在初级保健网的基础上建立肿瘤防治网,开展肿瘤三级预防,以达到了“三早”,降低癌症死亡率和提高癌症病人的生活质量。     

Evaluation of a Navigator Program for Cancer Screening of Women in Korean Communities

The objectives of this study were to develop and evaluate a culturally acceptable navigator program for femalecommunity leaders to improve the cancer screening rates of Korean women. The study was designed to improveknowledge, self efficacy and communication skills for breast and cervical cancer screening, monitor navigator’sactivities and evaluate change of knowledge, motivation, behavioral skills of a selected community population.A total of 30 women aged from 40-69 who were educated in a 12 hour navigator program, and 210 of a 1,200community members in contact with cancer screening navigators were surveyed for evaluation of effectivenessof the navigator program. Contents of program were causes of cancer, benefit of breast cancer early detection,benefit of cervical cancer early detection, health care service for cancer screening, role of cancer early detectionnavigators, communication skills, trans-theoretical modeling and role play. Cancer screening was significantlyrelated to the change of knowledge by cancer screening navigator (OR=3.02, p<0.01), and changed skills fortaking screening (OR=2.46, p<0.05). This study showed that the navigator program could be applied effectivelyto communities in Korea, contributing to improvement of screening rates through community capacity building.     

The role of inadequate health literacy skills in colorectal cancer screening

Colorectal cancer is ideally suited for early detection strategies that are likely to improve survival rates. Screening with either a fecal occult blood test (FOBT) or flexible sigmoidoscopy has been shown to identify precancerous polyps or cancers in early stages. However, persons with limited education and of lower socioeconomic status infrequently participate in screening programs in general and have very low rates of colorectal screening. Low literacy, which is common among persons with limited education and low income, may be an overlooked factor in understanding patients' decision making about colorectal cancer screening. This article provides information from focus groups about colorectal cancer screening, which we examine in the context of relevant literature on cancer screening and literacy. Using the health belief model, we examine the association between inadequate health literacy skills and low rates of colorectal cancer screening. The theoretical model also provides insights into strategies for improving knowledge, attitudes, and beliefs and screening rates for this challenging patient population.     

Community- Based Approaches to Cancer Prevention in Rural Thailand Based on Experiences of Accredited Health Professionals

This qualitative research aimed to describe important components of community based approaches of cancer prevention from working experiences of accredited health professionals in Thai rural communities. Methods: Data were collected from 23 communities with 23 accredited health professionals as key participants using in-depth interview and focus group discussions (FGDs) in each community. Other informants were community leaders, community health volunteers and community people. Content analysis was applied for data analysis. Results: Community based approaches for cancer prevention from the experiences of accredited health professionals were composed of 2 themes: approaches for community-based cancer prevention and methods for cancer-based prevention in the community. The approaches for community-based cancer prevention was composed of 4 components: 1) primary prevention focusing on health education; 2) secondary prevention include: life style modification, vaccination, advocacy of cancer screening, early detection, and prompt refer; 3) tertiary prevention focusing on primary care, and 4) research collaboration focusing on net working.  Methods for cancer-based prevention in the community were different based on types of cancer.  The 3 factors determined to be associated with community based approaches for cancer prevention were: 1) primary care policy; 2) hometown workplace; and 3) health practice skill. Conclusion: Community based approaches for cancer prevention should concentrate on building a literate community involvement to empower both health care providers and residents. From our evidence, dedicated community associates health professionals have a major role to play.     

Looking ahead: a case for human papillomavirus testing of self-sampled vaginal specimens as a cervical cancer screening strategy

Even in the era of highly effective human papillomavirus (HPV) prophylactic vaccines, substantial reduction in worldwide cervical cancer mortality will only be realized if effective early detection and treatment of the millions of women already infected and the millions who may not receive vaccination in the next decade can be broadly implemented through sustainable cervical cancer screening programs. Effective programs must meet three targets: (i) at least 70% of the targeted population should be screened at least once in a lifetime, (ii) screening assays and diagnostic tests must be reproducible and sufficiently sensitive and specific for the detection of high-grade precursor lesions (i.e., CIN21), and (iii) effective treatment must be provided. We review the evidence that HPV DNA screening from swabs collected by the women in their home or village is sufficiently sound for consideration as a primary screening strategy in the developing world, with sensitivity and specificity for detection of CIN21 as good or better than Pap smear cytology and VIA. A key feature of a self-collected HPV testing strategy (SC-HPV) is the move of the primary screening activities from the clinic to the community. Efforts to increase the affordability and availability of HPV DNA tests, community education and awareness, development of strong partnerships between community advocacy groups, health care centers and regional or local laboratories, and resource appropriate strategies to identify and treat screen-positive women should now be prioritized to ensure successful public health translation of the technologic advancements in cervical cancer prevention.     

Breast cancer screening in an era of personalized regimens: A conceptual model and National Cancer Institute initiative for risk‐based and preference‐based approaches at a population level

Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in how population‐based breast cancer screening is approached, including advanced imaging technologies, health system performance measures, health care reform, concern for “overdiagnosis,” and improved understanding of risk. Maximizing benefits while minimizing the harms of screening requires moving from a “1‐size‐fits‐all” guideline paradigm to more personalized strategies. A refined conceptual model for breast cancer screening is needed to align women's risks and preferences with screening regimens. A conceptual model of personalized breast cancer screening is presented herein that emphasizes key domains and transitions throughout the screening process, as well as multilevel perspectives. The key domains of screening awareness, detection, diagnosis, and treatment and survivorship are conceptualized to function at the level of the patient, provider, facility, health care system, and population/policy arena. Personalized breast cancer screening can be assessed across these domains with both process and outcome measures. Identifying, evaluating, and monitoring process measures in screening is a focus of a National Cancer Institute initiative entitled PROSPR (Population‐based Research Optimizing Screening through Personalized Regimens), which will provide generalizable evidence for a risk‐based model of breast cancer screening, The model presented builds on prior breast cancer screening models and may serve to identify new measures to optimize benefits‐to‐harms tradeoffs in population‐based screening, which is a timely goal in the era of health care reform. Cancer 2014;120:2955–2964. © 2014 American Cancer Society.     

Evaluation of Efficacy of Self Breast Examination for Breast Cancer Prevention: a Cost Effective Screening Tool

Breast cancer is the most prevalent neoplasm among females and every year the number of associated deaths ‍increases so that there is a dire need for implementation of cancer screening and early detection. A survey conducted ‍by various locally organised cancer registries indicated breast cancer to be the most prevalent cancer among females ‍and the second most common cause of cancer deaths among Pakistani women. Since Pakistani females do not generally ‍engage in screening practices we argue that nurses and lady health workers should team up to educate women for ‍the possible early detection of cancer using Self Breast Examination as a screening tool. In this paper, we attempt to ‍evaluate the primary efficacy of self breast examination as an early and cost effective cancer screening measure, and ‍to discuss the relation of community health nurses as well as the lady health workers to education of females of low ‍income countries such as Pakistan to possibly lower the cancer burden.     

Development of a cancer prevention-detection clinic

Control of cancer through risk reduction and early detection has great potential. Roswell Park Memorial Institute's Prevention-Detection Center addresses a community need for health promotion, disease prevention, and cancer detection as well as providing opportunity for research on the efficacy of such a program. The Prevention-Detection Center offers a range of services including education, genetic counseling, risk assessment, counseling in smoking cessation and other means of risk reduction, and screening for cancer. It is also involved in evaluation of new technologies of cancer detection such as the ultrasonic examination of the breast. A community outreach program is aimed at attracting high-risk populations. In its first eighteen months of operation; the Prevention-Detection Center detected 24 confirmed cancers. The Center is used by approximately 60 persons each week. Interviews with persons using the clinic over a two-week period indicate that most are motivated to attend because a relative has had cancer or because of a belief in the importance of regular checkups. Client satisfaction with the clinic is high. Although many of the activities of the Prevention-Detection Center have a research dimension, many of its activities and services are suited to the community ambulatory health care setting.     

Strategies for Increasing Colorectal Cancer Screening Among African Americans

Abstract

African Americans bear a disproportionate burden of mortality from colorectal cancer. Because the majority of excess deaths are linked to delayed detection (after the cancer has spread), interventions to promote acceptance of and compliance with screening are urgently needed. Tins article considers strategies to overcome barriers to screening for colorectal cancer among African Americans. The authors draw attention to the barriers that may be more influential among African Americans than in other groups: for example, fear of cancer, fatalism, reliance on self-care, limhed opportunities to creen, and inadequate provider-patient communication. Previous efforts to promote screening for breast cancer and other health behaviors suggest that community-based approaches designed to effect mutually reinforcing changes at the individual, community and health care system levels my be bist suited to raise awareness of colorectal cancer/promote acceptance of screening, and facilitate compliance in African American communities.