辽宁庄河胃癌早诊早治工作进展

[目的]探讨可持续开展癌症预防和早诊早治工作及基层肿瘤防治队伍能力建设的成功经验.[方法]总结胃癌早诊早治示范基地项目实施及进展情况,并进行资料分析.[结果]庄河现场胃癌早诊早治工作取得明显效果,早诊率80%.治疗率99%,诊断及治疗时效率均为100%.现场防治队伍能力建设取得长足进步.[结论]各级地方政府高度重视及大力支持是保证早诊早治项目顺利实施的关键,上级技术支撑单位的技术传、帮、带是保证技术方案落实到位的关键,基层肿瘤防治队伍能力建设是保证早诊早治项目可持续发展的关键.     

癌症早诊早治工作评价指标的探讨

[目的]探讨癌症早诊早治工作的评价指标。[方法]分析2006～2009年卫生部早诊早治项目宫颈癌、食管癌/贲门癌、结直肠癌、肝癌、鼻咽癌及胃癌的筛查和早诊早治数据,提出并定义癌症早诊早治工作的初步评价指标。筛查早诊率,检出率和治疗率为工作绩效指标;早期发现成本系数（early detection cost index,EDCI）为综合评价指标。[结果]宫颈癌、食管癌/贲门癌、结直肠癌、肝癌、鼻咽癌及胃癌6种癌症的诊断性筛查检出率分别为：5.6%、2.4%、3.9%、1.3%、5.5%、1.5%;筛查早诊率分别为：93.5%、82.3%、91.9%、58.2%、60.0%、80.0%;治疗率分别为：90.9%、68.4%、100%、69.1%、80.0%、85.0%;早期发现成本系数分别为：0.22、0.42、0.48、0.80、2.45、1.68。[结论]宫颈癌、结直肠癌及食管癌/贲门癌的早诊早治有良好的效益,应进一步推广。     

辽宁省农村大肠癌早诊早治实践与探索

[目的]探索并总结农村开展大肠癌早诊早治项目的方法、问题和效果。[方法]分析辽宁省2012年12月至2014年9月大肠癌筛查资料,探讨40~74岁适龄人群早诊早治效果。[结果 ]初筛35 999人,肠镜检查3665人,确诊大肠癌23例,其中早期癌16例,中晚期癌7例,进展期腺瘤164例。检出率5.10%,早诊率96.26%,治疗率95.72%。[结论]农村开展肠镜筛查实施大肠癌早诊早治项目是必要的、也是可行的,与医院的发展相结合是项目工作可持续性要素之一。     

四川盐亭县食管癌筛查和早诊早治的绩效评价

[目的]评价盐亭县2006~2011年食管癌筛查和早诊早治项目的开展情况及其其效果。[方法]收集2006~2011年盐亭当地人口情况、食管癌发病死亡登记资料以及2006~2011年间食管癌筛查和早诊早治的相关资料,比较筛查人群与当地非筛查人群的早诊早治情况以及患者的预后情况,并对项目组工作人员进行定性访谈。[结果]2006~2011年共计筛查40~69岁年龄段人群15065人,发现阳性病例1186例。除2006年,其余各年食管癌筛查的早诊率均超过了70%,总的早治率为96.58%。筛查人群中食管癌患者的1年、2年及5年生存率均明显高于非筛查人群(P<0.001)。[结论]食管癌筛查及早诊早治项目确可做到癌症早发现、早诊断及早治疗。在食管癌高发区开展筛查及早诊早治,对于提高当地人群的生存率和生命质量,减少患者的医疗费用以及节省当地卫生资源都具有重要意义。     

河南食管癌高发区食管癌/贲门癌早诊早治项目实践与探索

[目的]总结探索在食管癌高发区实施食管癌/贲门癌早诊早治项目的效果和问题。[方法]分析2009～2010年林州、辉县、济源三市在40～69岁人群中,进行内镜食管贲门癌筛查资料,探讨适宜筛查人群和早诊早治效果。[结果]三市2009～2010年共筛查13071人,发现癌症病例369例,检出率2.82%,其中早期癌323例,早诊率87.53%。林州272例治疗患者治疗率为64.34%。[结论]在食管癌高发区高危人群中,开展内镜筛查实施早诊早治是可行的,将筛查人群定为40～74岁年龄组可能更有意义。     

信息化平台助推癌症筛查和早诊早治管理精准化探索

摘 要：我国癌症筛查和早诊早治工作蓬勃发展，取得显著成绩的同时也存在信息不对称、医生能力不均衡、阳性人员追踪不到位、资源分配不科学等问题。推进癌症筛查和早诊早治管理精准化，就要对项目进行全流程、全周期、全方位的精准化管理，要做到精准识别、精准传递、精准追踪、精准供给来提升癌症筛查和早诊早治的工作质量。北京市将信息化管理平台投入到癌症筛查和早诊早治工作中，实现了癌症筛查和早诊早治信息的区域化管理，基本形成癌症筛查和早诊早治工作信息数字化、资源网络化、服务智能化、监管一体化的服务体系，具有较好的应用性及推广价值。     

中国癌症早诊早治的实践与思考

文章概述癌症早诊早治示范基地及中央转移支付项目的进展,并以检出率、早诊率及治疗率作为近期评价工作的指标。5年工作经验表明,试点示范工作在癌症早诊早治的推广中具有重要意义,而政府重视及基层队伍的技术培训在其中起着关键作用。中国癌症早诊早治工作的目标是,使癌症早诊早治逐步成为经常性公共卫生服务的一部分。为此应积极准备条件：加强健康促进,使更多筛查对象积极主动地参与;加强基层能力建设,造就合格的基层技术队伍;合理的制度安排,使符合成本—效益原则的筛查方案与医疗保障制度相结合。     

中国城市癌症早诊早治项目进展

摘 要：城市癌症早诊早治项目是国家重大公共卫生服务项目,项目自2012年立项至今,紧紧围绕着设计目标开展了人群风险评估、临床筛查、卫生经济学评价和随访等工作,并积极探索适合我国国情的、经济有效的城市癌症早诊早治技术方案和管理模式,以提高癌症早诊率、降低癌症死亡率。     

北京市癌症早诊早治信息系统的研制与应用

摘 要：［目的］ 利用现代信息技术建立癌症早诊早治信息平台,为优化项目工作流程、减轻基层工作量、开展癌症早诊早治工作评价和防治措施效果评估提供支撑。［方法］ 从平台技术框架、业务流程与数据库、信息交换与共享、数据安全防护、子系统功能、数据管理与分析等方面对北京市癌症早诊早治信息系统平台进行阐述。［结果］ 北京市癌症早诊早治信息平台以社区医生系统、临床医生系统、卫生经济学评价系统、生物样本管理系统和统计决策支持系统为基本操作平台,具备风险人群评估、高危人群预约筛查、临床筛查管理、跟踪随访、临床诊治管理、卫生经济学评价、生物样本管理和统计报表等功能。平台对业务流程、数据流程和管理流程进行了梳理与优化,采用网络数据实时上报的模式,保证了数据的时效性、准确性和安全性。［结论］ 北京市癌症早诊早治信息平台可以为癌症的预防和早期治疗提供支撑工具,为医疗工作者和管理者提供更加科学、可靠的数据支撑。     

食管癌早诊早治普查顺应性的影响因素分析

[目的]探讨影响食管癌早诊早治普查顺应性的因素。[方法]分析2005~2010年磁县食管癌早诊早治胃镜普查中影响顺应性的因素。[结果]2005~2010年磁县食管癌早诊早治胃镜普查顺应性明显提高。抓住普查时机、消除社会恐惧心理、行政干预、强化舒适内镜概念为提高普查顺应性要素。[结论]进一步做好宣传发动工作,抓住普查时机,强化舒适内镜概念是提高顺应性的关键。     

沈阳市苏家屯地区大肠癌筛查结果分析

[目的]通过大肠癌早诊早治项目,分析沈阳市苏家屯地区居民大肠癌发病情况。[方法]对苏家屯地区40~74岁人群采用问卷调查和粪便潜血实验免疫金标法（FIT）相结合筛出高危人群,对高危人群进行全大肠镜检查。[结果]目标人群40 157人中接受初筛人数为16 893人,顺应率为42.07%。初筛出高危人群3139人,占筛查人数18.58%。进行肠镜检查1655人,顺应率为52.72%。检出进展期腺瘤、大肠癌及类癌共83例。早诊率为95.18%,治疗率为100%。苏家屯地区居民大肠癌检出率为37.35/10万。[结论]苏家屯地区大肠癌检出率略高于我国农村地区平均水平。大肠癌筛查方案适用于城郊地区开展,可提高大肠癌的早诊率,对提高治愈率及延长生存期有重要意义。     

上海市闵行区“六癌”早发现效果及影响因素分析

[目的]了解闵行区＂六癌＂（大肠癌、胃癌、肝癌、肺癌、乳腺癌、宫颈癌）早发现效果及其影响因素。[方法]对1999~2011年早发现登记队列中确诊的＂六癌＂与肿瘤登记系统中同期非队列人群确诊的＂六癌＂确诊期别、生存率及生存质量进行比较。[结果]＂六癌＂早期率,1年、3年、5年生存率和生存质量队列组均优于非队列组。基于社区的早发现模式效果好于基于医疗机构的早发现模式。影响患者生存的因素为：发病年龄、性别、家族史、手术性质、转移、患≥2个肿瘤、未经早发现干预,OR分别为：1.03、1.13、2.17、1.21、1.88、1.76、1.71。粘液性囊性肿瘤风险较高（OR=1.22,P=0.02）,腺癌、导管癌及鳞癌与上皮肿瘤相比死亡风险相当。患肠癌、胃癌、肝癌及肺癌较宫颈癌的死亡风险分别为：1.55、2.55、3.99、4.07,乳腺癌为宫颈癌死亡风险的0.66倍。[结论]两种早发现模式均有一定成效,基于社区的肿瘤早发现模式效果较优。＂六癌＂早发现、早诊断、早治疗,提高根治率是降低死亡风险的关键,尤其需要加强肝癌及肺癌的早诊早治工作。     

Individuals at high-risk for pancreatic cancer development: management options and the role of surgery

Pancreatic cancer (PC) is a highly lethal disease. Despite advances regarding the safety and long-term results of pancreatectomies, early diagnosis remains the only hope for cure. This necessitates the implementation of an intensive screening program (based mainly on modern imaging), which - given the incidence of PC - is not cost effective for the general population. However, this screening program is recommended for individuals at high-risk for PC development. Indications for screening include the following three clinical settings: hereditary cancer predisposition syndromes associated with PC, hereditary pancreatitis and familial pancreatic cancer syndrome. The aim of this strategy is to identify pre-invasive (precursor) lesions, which are curable. Surgery is recommended in the presence of recognizable lesion on imaging lesions. Partial (anatomic) pancreatectomy - depending on the location of the suspicious lesion - is the most widely accepted type of surgical intervention in this setting; occasionally, however, total pancreatectomy may be required, in carefully selected patients. Despite that experience still remains limited, there is evidence that this aggressive strategy allows early detection of neoplastic lesions, thereby improving the effectiveness of surgery and prognosis.     

Breast cancer mortality in Norway after the introduction of mammography screening

An organized mammography screening program was gradually implemented in Norway during the period 1996–2004. Norwegian authorities have initiated an evaluation of the program. Our study focused on breast cancer mortality. Using Poisson regression, we compared the change in breast cancer mortality from before to during screening in four counties starting the program early controlling for change in breast cancer mortality during the same time in counties starting the program late. A follow‐up model included death in all breast cancers diagnosed during the follow‐up period. An evaluation model included only breast cancers diagnosed in ages where screening was offered. The study group had been invited for screening one to three times and followed for on average of 5.9 years. In the follow‐up model, 314 breast cancer deaths were observed in the study group, and 523, 404 and 638, respectively, in the four control groups. The ratio between the changes in breast cancer mortality between early and late starting counties was 0.93 (95% confidence interval [CI] 0.77–1.12). In the evaluation model, this ratio was 0.89 (95% CI: 0.71–1.12). In Norway, where 40% of women used regular mammography prior to the program, the implementation of the organized mammography screening program was associated with a statistically nonsignificant decrease in breast cancer mortality of around 11%.     

胃癌高发现场高危人群综合防治研究

目的：通过对我国辽宁庄河及山东临朐胃癌高发区胃癌及其高危人群的筛选及癌前状态的干预研究。建立切实切可行的胃癌筛查方案,模索胃癌化学干预中期生物学评估指标。方法：利用血清胃蛋白酶原检测,双对比造影＋胃镜、胃粘膜活检两轮筛查法进行胃癌及其高危人群的筛选;利用限制性片断长度多态性分析方法对胃癌高危人群进行胃蛋白酶原C基因多态性检测,采用随机对照干预实验,对胃幽门螺杆菌感染者及高危人群分别实施抗幽门螺杆菌治疗、中药阻断治疗及大蒜素＋VitC治疗,并对干预效果进行评价;对全民进行以改变不良饮食习惯为主的群体行为干预。结果：庄河现场早期胃癌检出率为56．82％;现场普查中发现的胃癌患者3年生存率为7607％;作为胃癌初筛方法,血清胃蛋白酶原含量检测优于对比造影,国人血清胃蛋白酶原含量检测初筛胃癌的参考临界值（Cut-off)可以考虑由P1≤50＋P1／P2≤3;胃癌组胃蛋白酶原C基因EcorR Ⅰ稀有片断出现频率高于正常组而常见片断有缺失,对4例携带稀有片断的胃癌家系成员进行追踪随访,发现有2例分别在2．5年及5年后罹患者早期胃部,IL－8、PCNA、P53粘、粘蛋白与Hp感染呈正相关而p16与其呈负相关;细胞凋亡下Hp感染相关性胃疾病的发生发展过程相关。结论：庄河现场及监朐已成可以开展前瞻性胃癌流行病学、病因学及大规模人群筛查及随机对照干预实验的胃癌高发区研究 基地、胃癌高危人群一、二级预防一、二级预防初见成效。     

Follow-up strategies after curative resection of colorectal cancer

Consensus is lacking as to the best strategy for following patients who have undergone definitive surgical medical treatment for colon cancer. The goal of any surveillance program should be detection of recurrent disease at a sufficiently early time to allow subsequent curative therapy. Although periodic clinical examinations, laboratory tests, radiographic imaging, and carcinoembryonic antigen (CEA) testing have been utilized as a form of surveillance, such aggressive and costly intervention has not been validated through clinical studies. Four of the five randomized trials comparing such an intensive surveillance strategy to less frequent testing have not demonstrated the intensive approach to lead to an improvement in overall survival. Furthermore, intensive testing is both costly and has been shown not to improve quality of life. Further research designing appropriate postoperative testing is needed to guide physicians and patients after the curative resection of a colorectal cancer.     

上海市杨浦区医务人员癌症早发现知识调查

[目的]掌握杨浦区医务人员对癌症早发现知识的知晓情况。[方法]随机捕取13家医院的265名医务人员，采用面对面问卷调查方式了解调查对象对癌症早发现相关知识的知晓情况。[结果]95．36％的医生没完整掌握乳腺癌高危对象的判断标准；82．99％以上的医生没完整掌握肝癌高危对象的判断标准；81．11％医生没完整掌握胃癌前病变知识：69．59％的医生没完整掌握大肠癌的常见症状与高危对象的判断标准。[结论]杨浦区医务人员对乳腺癌、肝癌、胃癌、大肠癌的早发现知识还存在一定的认知差距。     

Development of a Colorectal Cancer Screening Intervention for Iranian Adults: Appling Intervention Mapping

Background: While the incidence rate of the colorectal cancer (CRC) has been increasing over the last three decades in Iran, very limited interventions to increase CRC screening have been developed for Iranian population. The purpose of this study was to describe the use of Intervention Mapping (IM) for applying theory and evidence and considering local contexts to develop a CRC screening program among adults in Iran. Materials and Methods: From April 2014 to July 2016 following the IM process, six steps were formulated and implemented. First a need assessment was conducted involving relevant stakeholders and using focus groups discussions (n=10), individual interviews (n=20), and a household survey (n= 480). Then a matrix of change objectives was developed for each behavioral outcome and theoretical methods and their practical applications were identified to guide intervention development and implementation. A multi-component intervention was developed and piloted. Decision on suitable parts of intervention was made based on feedback of pilot study. Finally, evaluation plan including process and outcome evaluation was generated and conducted to inform future scale up. Results: The needs assessment highlighted factors affecting CRC screening including knowledge, self efficacy, social support and perceived benefit and barriers (financial problems, fear of detection of cancer and etc). Results of needs assessment were used to develop next steps IM. The program utilized methods like information delivery, modeling, and persuasion. Practical applications included video presentation, group discussion, role playing and postcards.This program was assessed through a cluster-randomized controlled trial. Results showed that there were significant differences in CRC screening uptake between intervention groups and control (P<0.001). Conclusions: IM is a useful process in the design of a theory-based intervention addressing CRC screening among Iranian population.     

食管癌筛查和早诊早治的实践与经验

[目的]报告在高发区居民中食管癌筛查和早诊早治的效果和经验。[方法]分析2006—2008年在6个省中的8个县（市）居民中,开展食管癌筛查和早诊早治的资料。总结工作中的效果和经验。[结果]3年内镜检查共39221人,发现食管癌600例,检出率为1．53％。其中早期食管癌515例,早诊率85．83％。同时,发现胃贲门癌413例,检出率为1．05％。其中,早期贲门癌336例,贲门癌的早诊率81.36％。[结论]食管癌内镜筛查可发现大批早期癌和癌前病变,现阶段作为食管癌防治措施是可行的和有效的。