PET-CT进行癌症早期筛查的初步研究

目的评价^18F—PET-CT进行肿瘤筛查的价值。方法2006年9月～2008年11月在我院行PET—CT检查进行肿瘤筛查者72例，男性50人，女性22人，年龄30～80岁（中位46岁）。吸烟者及曾经吸烟者20人，吸烟量10～40包／年，承认二手吸烟者23人。所有受检者行全身PET—CT显像，范围为头顶至双大腿上段。PETCT扫描后行屏气低剂量胸部螺旋CT扫描（扫描参数为120KV，32mAs，125mm层厚）。对所有图像进行分析记录。结果发现恶性肿瘤2例（27％），均有局部放射性摄取增高：肺癌1例（T1N0M0），甲状腺癌1例（T1N1M0）。发现良性肿瘤；例（甲状腺腺瘤）。发现肺非钙化性结节28例（38.3％，多发14例，单发14例，直径5mm～21mm），除1例外均无明显放射性摄取增高。6例纵隔及肺门淋巴结出现放射性摄取增高（最大SUV1.1～71），其中含钙化1例。头部及腹部未见重要异常发现。电话随诊41例（时间3～15个月）均无异常发现。结论全身PET—CT可检出多种早期肿瘤。     

Language and use of cancer screening services among border and non-border Hispanic Texas women

Objectives. Compared to other groups, Mexican American women screen less frequently for cervical and breast cancer. The most significant barriers reported by previous researchers include not having a usual source of care, lacking health insurance and English-language difficulties. In this paper we document and examine the factors associated with disparities in cancer screening between border and non-border residents by language of interview (Spanish or English) among Texas Hispanic women. We hypothesize that, controlling for socioeconomic and demographic characteristics, border residents are more likely to utilize screening services than non-border residents because of the greater presence of bilingual services in border counties.

Design. We follow the framework of the Behavioral Model for Vulnerable Populations proposed by Gelberg et al. (Health Services Research, vol. 34, no. 6, pp. 1273–1302, 2000). This model conceptualizes use of health care as an outcome of the interplay of predisposing, enabling and need factors and recognizes that vulnerable groups face additional barriers to health care utilization. Data come from the 2000, 2002 and 2004 Texas Behavioral Risk Factor Surveillance surveys.

Results. Group differences in cancer screenings are explained largely by socioeconomic characteristics and structural barriers to access. The significance of language of interview and of border residence disappear after controlling for factors such as health insurance, income and a usual source of care.

Conclusion. Women who selected to be interviewed in Spanish were less likely to report age-appropriate cancer examinations, health insurance and a regular health care provider than those who selected to be interviewed in English. Disparities in cancer screenings among vulnerable Hispanic populations could be reduced by promoting the establishment of a regular health care provider.     

How Do Older Chinese Women View Health and Cancer Screening? Results from Focus Groups and Implications for Interventions

Objective. To qualitatively assess Chinese American women's views of health and illness and the potential influences of culture and language on cancer screening behavior.

Design. Data were generated by five focus groups, each consisting of 9–12 Chinese American women aged 50 and older. Participants responded to open‐ended questions assessing their perceptions of health and illness, knowledge about cancer, beliefs about and barriers to cancer screening, and screening and healthcare experiences in the USA. All conversations were tape‐recorded and analyzed in the context of PRECEDE framework concepts of predisposing, enabling, and reinforcing factors.

Results. The 54 participants had a mean age of 65 years, with an average age of immigration to the USA at 51 and average length of residence in the USA of 15 years. Participants considered outdoor exercise in the morning for fresh air and a hot–cold balanced diet as important means to health. None mentioned the importance of regular medical checkups or cancer screening. When talking about cancer prevention, a sense of fatalism was evident, such as ‘no control of life and death’ and ‘what will happen will happen’. Lack of English capability was a major enabling barrier to healthcare. In addition, these women reported the need for help with transportation, especially for those living in suburban areas where public transportation is not readily available. Physician recommendation was identified as the most important reinforcing factor for cancer screening.

Conclusion. Our results suggest traditional Chinese beliefs, such as those pertaining to fatalism, self‐care, and the hot and cold balance, influence the perceptions of older Chinese women regarding health, illness, and use of preventive healthcare. Interventions to improve cancer screening in this population should be tailored to the specific predisposing, enabling, and reinforcing factors of this population, including cultural views, language barriers, doctor–patient communication, and access to healthcare.     

Cost-Effectiveness of Earlier or More Intensive Colorectal Cancer Screening in Overweight and Obese Patients

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Las Mujeres Saludables: Reaching Latinas for Breast, Cervical and Colorectal Cancer Prevention and Screening

Community health advisors have effectively promoted breast and cervical cancer prevention and screening among low-income Latina women. Specific elements of such programs, such as enhanced social support, may explain successes. Promotion of colorectal cancer screening has been less studied. Promotoras de Salud (i.e., Latina health advisors) implemented a 12-week program among women recruited from community-based organizations. The program educated 366 Latinas in breast, cervical and colorectal cancer prevention and screening and emphasized social support among class members. Pre-and post-intervention assessments demonstrated significant increases for fruit and vegetable consumption (3.05 to 3.60 servings/day), and physical activity (65.15 to 122.40 minutes/week). Of women previously non-compliant, 39 percent, 31 percent and 4 percent received Pap tests, mammography, and fecal occult blood test (FOBT), respectively. A culturally aligned education program using community health advisors and emphasizing social support among participants may improve prevention and selected screening behaviors, but more intensive interventions may be required for colorectal cancer screening compliance. Supported by a grant from St. Luke’s Charitable Health Trust, Phoenix, Arizona.     

癌症筛查筹资的国际比较及启示

目的:为我国癌症筛查筹资提供政策性建议,提高人群健康和卫生服务公平性。方法:通过文献和报告回顾及相关网站浏览,总结并比较我国及世界主要国家癌症筛查的筹资方式及实践特点。结果:大多数发达国家和地区已将宫颈癌、大肠癌和乳腺癌筛查纳入公共卫生服务。我国目前主要采用中央财政专项转移支付方式,已实施了多项癌症筛查和早诊早治国家重大公共卫生服务项目,极大地改善了地区间公共卫生服务的不平等。然而,因人口众多而资源有限,且各地区发展不平衡,癌症筛查筹资方式仍有较大的人群和地区差异。结论:我国癌症筛查筹资与发达国家存在较大差距,需充分利用现有资源,拓宽筹资渠道,逐步实现癌症筛查项目的社会公益属性。