肺癌的筛查

肺癌的筛查目前仍是一个有争议的问题.本文讨论了肺癌筛查的必要性和可行性,对肺癌筛查的历史和现状以及新的影像学和分子生物学技术在肺癌筛查和早期诊断中的价值和应用前景进行了回顾.利用生物标志物进行肺癌的筛查仍处于研究阶段,尚需前瞻性的研究对其效果进行评价.低剂量螺旋CT是目前最有希望用于人群肺癌筛查的新技术.肺癌的筛查应根据不同的卫生资源情况利用多种筛查技术采取不同的筛查策略在肺癌高危人群中进行.     

Screening for breast cancer

This review will give a general overview of the impact of breast cancer, as well as breast cancer risk factors, identification of high-risk groups, screening modalities, and guidelines for screening average-risk and high-risk individuals, including a case discussion of the primary care provider’s approach to screening.     

Breast cancer screening uptake in women at increased risk of developing hereditary breast cancer

This multicenter study assessed breast cancer screening uptake in 461 unaffected women at increased risk of developing breast cancer on the basis of family history who approached familial cancer clinics for advice about surveillance options. At the time of attending the clinic, 89% and 90% of participants were vigilant with respect to age- and risk-specific recommendations for mammography and clinical breast examination, respectively, and 51% reported practicing breast self-examination monthly or more frequently. The degree to which health outcomes are perceived to be under one's personal control (²=–2.09, p=0.0037) and breast cancer anxiety (²=8.11,p=0.044) were both associated with monthly or more frequent breast self-examination, while there were no associations with sociodemographic characteristics. A significantly lower percentage (56%) of women aged <30 were vigilant with respect to mammography recommendations, compared to 77%, 96% and 98% of women aged 30–39, 40–49 and >50, respectively (²=37.2,p<0.0001). These relatively low rates of mammographic screening in young women may reflect concerns about increased cancer risk associated with early and repeated radiation exposure or lack of sensitivity in young women with radiographically dense breasts. If mammographic screening is ultimately shown to lower mortality in women at high risk, there will be a strong case to promote screening in young women. The need for regular mammographic screening would then need to be highlighted and reinforced amongst young women and their referring physicians. Awareness amongst general practitioners, who are largely responsible for referral to screening services, would also need to be increased.     

TruScreen系统在宫颈癌筛查中的应用效果

目的：探讨宫颈癌筛查系统TruScreen（TS）在宫颈癌筛查中的应用效果。方法回顾性分析368例检查者,分为TS检测组和TCT检测组,每组184例,TS检测组行TS检测,TCT检测组行液基薄层细胞学（TCT）检测,以组织病理学为诊断标准,比较TS与TCT检查在宫颈癌筛查中的应用效果。结果 TS检测组与TCT检测组检测敏感度分别为93.2%、100%,特异度分别为76.0%、75.0%,阳性符合率分别为64.7%、55.7%。结论 TS检测与TCT检测在宫颈癌筛查中具有相似的检测效果,值得临床推广和运用。     

Canadian cancer screening disparities: a recent historical perspective

Across Canada, introduction of the Pap test for cervical cancer screening, followed by mammography for breast cancer screening and, more recently, the fecal occult blood test for colorectal cancer screening, has contributed to a reduction in cancer mortality. However, another contribution of screening has been disparities in cancer mortality between certain populations. Here, we explore the disparities associated with breast and cervical cancer screening and preliminary data concerning disparities in colorectal cancer screening.Although some disparities in screening utilization have been successfully reduced over time (for example, mammography and Pap test screening in rural and remote populations), screening utilization data for other populations (for example, low-income groups) clearly indicate that disparities have existed and continue to exist across Canada. Organized screening programs in Canada have been able to successfully engage 80% of women for regular cervical cancer screening and 70% of women for regular mammography screening, but of the women who remain to be reached or engaged in regular screening, those with the least resources, those who are the most isolated, and those who are least culturally integrated into Canadian society as a whole are over-represented. Population differences are also observed for utilization of colorectal cancer screening services.The research literature on interventions to promote screening utilization provides some evidence about what can be done to increase participation in organized screening by vulnerable populations. Adaption and adoption of evidence-based screening promotion interventions can increase the utilization of available screening services by populations that have experienced the greatest burden of disease with the least access to screening services.     

Underuse of colorectal cancer screening among men screened for prostate cancer

BACKGROUND:

Evidence suggests that colorectal cancer (CRC) screening reduces disease‐specific mortality, whereas the utility of prostate cancer screening remains uncertain. However, adherence rates for prostate cancer screening and CRC screening are very similar, with population‐based studies showing that approximately 50% of eligible US men are adherent to both tests. Among men scheduled to participate in a free prostate cancer screening program, the authors assessed the rates and correlates of CRC screening to determine the utility of this setting for addressing CRC screening nonadherence.

METHODS:

Participants (N = 331) were 50 to 70 years old with no history of prostate cancer or CRC. Men registered for free prostate cancer screening and completed a telephone interview 1 to 2 weeks before undergoing prostate cancer screening.

RESULTS:

One half of the participants who underwent free prostate cancer screening were eligible for but nonadherent to CRC screening. Importantly, 76% of the men who were nonadherent to CRC screening had a regular physician and/or health insurance, suggesting that CRC screening adherence was feasible in this group. Furthermore, multivariate analyses indicated that the only significant correlates of CRC screening adherence were having a regular physician, health insurance, and a history of prostate cancer screening.

CONCLUSIONS:

Free prostate cancer screening programs may provide a teachable moment to increase CRC screening among men who may not have the usual systemic barriers to CRC screening, at a time when they may be very receptive to cancer screening messages. In the United States, a large number of men participate in annual free prostate cancer screening programs and represent an easily accessible and untapped group that can benefit from interventions to increase CRC screening rates. Cancer 2010. © 2010 American Cancer Society.     

Screening for breast cancer in a high-risk series

A unique cohort of women at increased risk of breast cancer because of prior X-ray treatment of acute mastitis and their selected high-risk siblings were offered periodic breast cancer screening including physical examination of the breasts, mammography, and thermography. Twelve breast cancers were detected when fewer than four would have been expected based on age-specific breast cancer detection rates from the National Cancer Institute/American Cancer Society Breast Cancer Demonstration Detection Projects. Mammograpy was positive in all cases but physical examination was positive in only three cases. Thermography was an unreliable indicator of disease. Given the concern over radiation-induced risk, use of low-dose technique and of criteria for participation that select women at high risk of breast cancer will maximize the benefit/risk ratio for mammography screening.     

山西省襄垣县宫颈癌和乳腺癌联合筛查效果初探

目的 通过分析为国家宫颈癌和乳腺癌筛查提供基本评价数据.方法 2009～2010年山西省襄垣县妇幼保健院对该县30～59岁妇女通过醋酸/碘染色后肉眼观察方法开展宫颈癌筛查,阳性者转诊阴道镜,镜下有病变时取活检,以病理诊断为金标准.对35～59岁的妇女开展乳腺癌筛查,以临床检查法为初筛方法,怀疑阳性者通过超声或乳腺X线进行诊断.结果 2009年完成1993名妇女的宫颈癌筛查,其中宫颈上皮内瘤变2级(CIN2)及以上病变的患病率为1.6%,早诊率为100%,第2年复查率为91%,仅查出1例CIN2,未查出更高病变,早诊率达100%.完成1819名妇女的乳腺癌筛查,乳腺良性病变9例(4.02%),良性肿瘤3例(1.34%);2010年完成2026名妇女的乳腺癌筛查,良性病变103例(13.57%),良性肿瘤14例(1.84%),可疑恶性1例.结论 该县宫颈癌的筛查效果明显,乳腺癌筛查仍需加强技术培训.筛查体系和技术队伍建设是基层单位承担农村妇女健康保健服务的关键.     

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.     

宫颈癌筛查中即查即治的临床体会

目的：探讨在宫颈癌筛查中阴道镜检查和即查即治的临床价值。方法：回顾性分析2007年3月至2009年3月在陕西省妇科普查工作中通过阴道镜检查及LEEP刀对宫颈疾病进行即查即治的临床效果。结果：宫颈癌普查3526例,其中408例行阴道镜下活检。阴道镜对宫颈疾病诊断的灵敏度为97．3％,特异度99．1％,准确度80．8％;即查即治的患者119例,其在宫颈疾病诊断的灵敏度84．5％,特异度93．2％,准确度为85．2％。结论：阴道镜诊断与组织病理学诊断有较高的符合率,对宫颈疾病诊断有非常高的应用价值;在边远山区进行宫颈癌的筛查中完成即查即治,具有十分重要的社会意义。     

Conundrums in screening for cancer

Screening for cancer has to be carefully organized for maximum effectiveness, and introduced in full understanding of the natural history of the disease. There are major potential harms as well as benefits from screening. The current state of art for breast, cervix and prostate cancer screening is reviewed, only for breast and cervix are policies of screening in the population justified.     

Screening for lung cancer

This review will comprise a general overview of the epidemiology of lung cancer, as well as lung cancer risk factors, screening modalities, current guideline recommendations for screening, and our approach to lung cancer screening.     

Disparities in cancer screening in individuals with a family history of breast or colorectal cancer

BACKGROUND:

Understanding racial/ethnic disparities in cancer screening by family history risk could identify critical opportunities for patient and provider interventions tailored to specific racial/ethnic groups. The authors evaluated whether breast cancer (BC) and colorectal cancer (CRC) disparities varied by family history risk using a large, multiethnic population‐based survey.

METHODS:

By using the 2005 California Health Interview Survey, BC and CRC screening were evaluated separately with weighted multivariate regression analyses, and stratified by family history risk. Screening was defined for BC as mammogram within the past 2 years for women aged 40 to 64 years; for CRC, screening was defined as annual fecal occult blood test, sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years for adults aged 50 to 64 years.

RESULTS:

The authors found no significant BC screening disparities by race/ethnicity or income in the family history risk groups. Racial/ethnic disparities were more evident in CRC screening, and the Latino‐white gap widened among individuals with family history risk. Among adults with a family history for CRC, the magnitude of the Latino‐white difference in CRC screening (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.11‐0.60) was more substantial than that for individuals with no family history (OR, 0.74; 95% CI, 0.59‐0.92).

CONCLUSIONS:

Knowledge of their family history widened the Latino‐white gap in CRC screening among adults. More aggressive interventions that enhance the communication between Latinos and their physicians about family history and cancer risk could reduce the substantial Latino‐white screening disparity in Latinos most susceptible to CRC. Cancer 2011;. © 2011 American Cancer Society.     

Role of mammography screening as a predictor of survival in postmenopausal breast cancer patients

We examined the effect of population-based screening programme on tumour characteristics by comparing carcinomas diagnosed during the prescreening (N=341) and screening (N=552) periods. We identified screen detected (N=224), interval (N=99) and clinical cancer (N=229) cases. Median tumour size and proportion of axillary lymph node negative cases were 1.5 cm and 65% in the screen detected group, 2.0 cm and 44% in cases found outside the screening, and 3.2 cm and 41% in the cases from the prescreening period. Survival of the breast cancer patients was 66% (95% CI, 60-71%) in the prescreening era group and 73% (95% CI, 66-78%) in the screening era group after 10 years of follow-up. In the screening era group the survival of the screen detected cases was 86% (95% CI, 80-90%) and that of the clinical cancer cases 73% (95% CI, 66-78%) after 10 years. In multivariate analysis the risk of breast cancer death was not significantly different between the prescreening and screening periods (HR 0.82; 95% CI 0.59-1.12, P=0.21). Detection by screening was not an independent prognostic factor in multivariate analysis (HR 0.75; CI 95% 0.50-1.12; P=0.17).     

Early detection of pancreatic cancer

Pancreatic adenocarcinoma is a low-incident but highly mortal disease. It accounts for only 3% of estimated new cancer cases each year but is currently the fourth common cause of cancer mortality. By 2030, it is expected to be the 2^nd leading cause of cancer death. There is a clear need to diagnose and classify pancreatic cancer at earlier stages in order to give patients the best chance at a definitive cure through surgery. Three precursor lesions that distinctly lead to pancreatic adenocarcinoma have been identified, and we have increasing understanding the non-genetic and genetic risk factors for the disease. With increased understanding about the risk factors, the familial patters, and associated accumulation of genetic mutations involved in pancreatic cancer, we know that there are mutations that occur early in the development of pancreatic cancer and that improved genetic risk-based strategies in screening for pancreatic cancer may be possible and successful at saving or prolonging lives. The remaining challenge is that current standards for diagnosing pancreatic cancer remain too invasive and too costly for widespread screening for pancreatic cancer. Furthermore, the promises of noninvasive methods of detection such as blood, saliva, and stool remain underdeveloped or lack robust testing. However, significant progress has been made, and we are drawing closer to a strategy for the screening and early detection of pancreatic cancer.     

The standardized development method of the Japanese guidelines for cancer screening

Background: To reduce cancer mortality, effective screening should be implementedproperly. In Japan, the Research Group for Cancer Screeningdeveloped screening guidelines; however, the development processwas not well established. Methods: Based on the development processes of other guidelines, an originalmethod, unique to Japan, was established to develop the Japanesecancer screening guidelines. Results: The guideline development process involved the following steps:topic selection, development of the analytic framework, systematicliterature review, translation to recommendations, consultationand publication. Mortality reduction related to cancer screeningwas evaluated using both direct and indirect evidence. To selectappropriate articles, an analytic framework for cancer screeningprogram with key questions was developed. Direct evidence wasdefined as a single body of evidence that established the linkagebetween screening and health outcomes such as mortality andincidence. The use of indirect evidence to determine the levelof evidence was limited to situations where test accuracy couldbe compared with that of a method whose evidence was supportedby randomized, controlled trials. Eight levels of evidence weredefined based on the study design and quality. The benefitsof each screening modality were determined based on the levelof evidence according to the results of the systematic review.Balancing the benefits and harms, five grades of recommendationwere formulated for population-based and opportunistic screening.After organized consultations, three types of guidelines werepublished. Conclusion: We developed a unique, standardized method for developing cancerscreening guidelines in Japan. Based on this process, previouslydeveloped cancer screening guidelines have been revised.     

Interval cancer and survival in a randomized breast cancer screening trial in Stockholm

The aim of the present study was to analyse the survival rate in a group of breast cancers detected in the intervals between screening examinations in relation to clinically detected cancers in a non-screened population. All interval and control cancers were recruited from a randomized controlled mammography screening trial in Stockholm. The overall survival up to eight years of observation was higher in 191 patients with interval cancers than in 142 control cancers (p=0.01). There were no significant differences between the two groups with regard to tumor size, stage distribution, or mean age, though the interval group did have a larger proportion of younger women. The similarity was confirmed by multiple regression analysis. The overall survival stage by stage was consistently higher in interval cancers. The survival rate in the true interval cancers was similar to that for those found in retrospect to have been detectable or traceable at the time of screening. No correlation was found between the length of the interval and the survival of patients with interval cancers. These results contradict the hypothesis that a high growth rate is associated with a poorer prognosis and that interval cancers are a more aggressive form of breast neoplasia.