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| 以社区为基础的群体医学在恶性肿瘤预防和控制中的重要意义 | |
| 引用本文： | 曹广文. 社区流行病学研究是探索恶性肿瘤病因和评估预防控制效果的关键[J]. 上海预防医学, 2018, 30(2): 83-88. DOI: 10.19428/j.cnki.sjpm.2018.18666 |
| 作者姓名： | 曹广文 |
| 作者单位： | 第二军医大学流行病学教研室，上海 200433 |
| 基金项目： | 国家重点基础研究发展计划(973计划)(2015CB554000) |
| 摘 要： | 随着人口老龄化程度的加深，心脑血管疾病和恶性肿瘤已经是我国人口主要死亡原因。恶性肿瘤是人群平均寿命之前，尤其是工作人群(≤60岁)的主要死亡原因。从人群疾病控制角度来看，恶性肿瘤分三大类。第一类是高度恶性肿瘤，如胰腺癌、肝癌、消化道印戒细胞癌和小细胞肺癌等。这类恶性肿瘤进展快、治疗效果差，对这类种类防制的重点是对高危人群进行病因预防，即一级预防，以降低人群发病率；第二类是中等恶性肿瘤，如结直肠癌、非小细胞肺癌、乳腺癌等，这类肿瘤进展较慢，对治疗反应较好，而且均有明显的癌前病变，通过对癌前病变的治疗如手术切除可以降低癌症发病率，这类肿瘤适合早期筛查、早期诊断和早期治疗，即二级预防，以降低人群死亡率；第三类是低度恶性(惰性)肿瘤，如前列腺癌、甲状腺癌等，这类肿瘤基本上对人群期望寿命不造成损害，积极治疗也难以提升患者的有效生存，对这类肿瘤防制的重点是治疗转移，即三级预防。对恶性肿瘤不加以分类地进行过度诊断和过度治疗不但对患者造成精神损伤和经济负担，而且对有效生存无益，浪费医疗资源。阐明恶性肿瘤病因，评估恶性肿瘤的流行状况、疾病负担、预防效果甚至各种临床治疗方案的效果均依赖于以社区为主的肿瘤流行病学研究。 |
| 关 键 词： | 社区 恶性肿瘤新分类 预防控制 过度治疗 |
| 收稿时间： | 2018-01-31 |
Follow-up of prostatectomy versus observation for early prostate cancer |
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| Guang-wen CAO. Community-based epidemiological study is indispensible for exploration of cancer etiology and evaluation of cancer prophylaxis and control[J]. Shanghai Journal of Preventive Medicine, 2018, 30(2): 83-88. DOI: 10.19428/j.cnki.sjpm.2018.18666 | |
| Authors: | Guang-wen CAO |
| Affiliation: | Department of Epidemiology, Second Military Medical University, Shanghai 200433, China |
| Abstract: | With the increasing ageing tendency of population, cardiovascular diseases and malignancies are the major causes of human death in China.Malignant diseases are the major cause of death of subjects who died prior to the average life expectancy, especially for the working population (60 years or less).For disease control prospective, malignant diseases can be classified into three categories.First category is the highly malignant tumors including pancreas cancer, liver cancer, gastrointestinal signet ring cell cancer, and small cell lung cancer.Malignancies of this category progress rapidly and respond poorly to routine therapy.The emphasis of controlling malignancies of this category is the etiological prevention, that is, first-grade prophylaxis, to reduce the incidence.Second category is moderately malignancies including colorectal cancer, non-small cell lung cancer, and female breast cancer.Malignancies of this category progress moderately and respond better to routine therapy.Moreover, malignancies of this category usually have precancerous lesions.Treatments for the precancerous lesions such as surgical resection can greatly reduce the incidences. Malignancies of this category are suitable for early screening, early diagnosis, and early treatment, namely second-grade prophylaxis, to reduce the mortality.Third category is |
| Keywords: | community novel classification of malignancy prophylaxis and control over-treatment |
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